Provider Demographics
NPI:1821159914
Name:LLOYD, JOHN D (MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:LLOYD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W STEUBEN ST
Mailing Address - Street 2:
Mailing Address - City:BINGEN
Mailing Address - State:WA
Mailing Address - Zip Code:98605-9175
Mailing Address - Country:US
Mailing Address - Phone:509-493-1143
Mailing Address - Fax:877-644-1937
Practice Address - Street 1:1000 W STEUBEN ST
Practice Address - Street 2:
Practice Address - City:BINGEN
Practice Address - State:WA
Practice Address - Zip Code:98605-9175
Practice Address - Country:US
Practice Address - Phone:509-493-1143
Practice Address - Fax:877-644-1937
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60118130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2008803Medicaid