Provider Demographics
NPI:1689934929
Name:NELSON, LYNDY RAE (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:LYNDY
Middle Name:RAE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:DIMMITT
Mailing Address - State:TX
Mailing Address - Zip Code:79027-1146
Mailing Address - Country:US
Mailing Address - Phone:806-647-7777
Mailing Address - Fax:
Practice Address - Street 1:1450 HWY 86
Practice Address - Street 2:
Practice Address - City:DIMMITT
Practice Address - State:TX
Practice Address - Zip Code:79027
Practice Address - Country:US
Practice Address - Phone:806-647-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional