Provider Demographics
NPI:1538328786
Name:LOTT FARMER, LYNDIS MAGNOLIA
Entity Type:Individual
Prefix:
First Name:LYNDIS
Middle Name:MAGNOLIA
Last Name:LOTT FARMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KAAPUNI LOOP
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1712
Mailing Address - Country:US
Mailing Address - Phone:808-938-7026
Mailing Address - Fax:808-934-0071
Practice Address - Street 1:120 KEAWE ST
Practice Address - Street 2:SUITE 204-A
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2874
Practice Address - Country:US
Practice Address - Phone:808-938-7026
Practice Address - Fax:808-934-0099
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health