Provider Demographics
NPI:1598057689
Name:TICE, LINDSAY KAYE (PSY D)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:KAYE
Last Name:TICE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SOUTHGATE STE 13
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3973
Mailing Address - Country:US
Mailing Address - Phone:541-278-2222
Mailing Address - Fax:541-276-8405
Practice Address - Street 1:1100 SOUTHGATE STE 13
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3973
Practice Address - Country:US
Practice Address - Phone:541-278-2222
Practice Address - Fax:541-276-8405
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3109103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500769085Medicaid