Provider Demographics
NPI:1548242498
Name:HALL, LYNNETTE KAY (LPC)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:KAY
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-1287
Mailing Address - Country:US
Mailing Address - Phone:417-533-5600
Mailing Address - Fax:417-533-5601
Practice Address - Street 1:304 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556-7101
Practice Address - Country:US
Practice Address - Phone:573-765-5141
Practice Address - Fax:573-765-3824
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004037101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499479202Medicaid