Provider Demographics
NPI:1629223979
Name:LT RESOURCES
Entity Type:Organization
Organization Name:LT RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUOG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MS
Authorized Official - Phone:608-366-1675
Mailing Address - Street 1:103 S WATER ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-1773
Mailing Address - Country:US
Mailing Address - Phone:608-366-1675
Mailing Address - Fax:608-269-1692
Practice Address - Street 1:103 S WATER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-1773
Practice Address - Country:US
Practice Address - Phone:608-366-1675
Practice Address - Fax:608-269-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3117125104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42254300Medicaid