Provider Demographics
NPI:1811011273
Name:YANCEY, LLOYD WAYNE (LPCCP)
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:WAYNE
Last Name:YANCEY
Suffix:
Gender:M
Credentials:LPCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 WORTH ST STE 725
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2089
Mailing Address - Country:US
Mailing Address - Phone:214-824-2510
Mailing Address - Fax:214-826-0130
Practice Address - Street 1:3409 WORTH ST STE 725
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2089
Practice Address - Country:US
Practice Address - Phone:214-824-2510
Practice Address - Fax:214-826-0130
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0081171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPF0081Medicare UPIN