Provider Demographics
NPI:1417178906
Name:NICKLE, LYNDA KAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:KAYE
Last Name:NICKLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MO
Mailing Address - Zip Code:65753-8104
Mailing Address - Country:US
Mailing Address - Phone:417-634-4203
Mailing Address - Fax:417-634-4505
Practice Address - Street 1:155 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753-8104
Practice Address - Country:US
Practice Address - Phone:417-634-4203
Practice Address - Fax:417-634-4505
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0028321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical