Provider Demographics
NPI:1639288418
Name:HOLLIMAN, LYNN BROOKS (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:BROOKS
Last Name:HOLLIMAN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13707 CHINKAPIN CIR
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7830
Mailing Address - Country:US
Mailing Address - Phone:620-412-7875
Mailing Address - Fax:
Practice Address - Street 1:205 S 5TH ST STE 22
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-2602
Practice Address - Country:US
Practice Address - Phone:913-565-2131
Practice Address - Fax:913-225-7984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020012657104100000X
KS23721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS06908OtherPROVIDER MEDICARE NUMBER
KS069838Medicare ID - Type UnspecifiedMEDICARE