Provider Demographics
NPI:1508148255
Name:GOLDSMITH, AUDRA LYN (LMLP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:LYN
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:LYN
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:T-LMLP
Mailing Address - Street 1:1600 N LORRAINE ST
Mailing Address - Street 2:STE 202
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-5670
Mailing Address - Country:US
Mailing Address - Phone:620-663-7595
Mailing Address - Fax:620-663-5263
Practice Address - Street 1:1600 N LORRAINE ST
Practice Address - Street 2:STE 202
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-5670
Practice Address - Country:US
Practice Address - Phone:620-663-7595
Practice Address - Fax:620-663-5263
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional