Provider Demographics
NPI: | 1710029202 |
---|---|
Name: | MCBAIN, LYNDA B (LMHC CAP CAPP) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | LYNDA |
Middle Name: | B |
Last Name: | MCBAIN |
Suffix: | |
Gender: | F |
Credentials: | LMHC CAP CAPP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 200 N EL MAR DR A203 |
Mailing Address - Street 2: | |
Mailing Address - City: | JENSEN BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34957-2570 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 772-229-8442 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2806 US1 SUITE C5 |
Practice Address - Street 2: | NEW HORIZONS OF THETREASURE COAST |
Practice Address - City: | FT PIERCE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34950 |
Practice Address - Country: | US |
Practice Address - Phone: | 772-467-3052 |
Practice Address - Fax: | 772-429-2165 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-02-13 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | CERTIFICATION #2203 | 101YA0400X |
FL | CERTIFICATION #890 | 101YA0400X |
FL | MH8049 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Not Answered | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |