Provider Demographics
NPI:1972987741
Name:DAILEY, LIDIA LYNETTE (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:LYNETTE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:LCDC
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 33046
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79120-3046
Mailing Address - Country:US
Mailing Address - Phone:806-471-3249
Mailing Address - Fax:877-339-0645
Practice Address - Street 1:2412 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6612
Practice Address - Country:US
Practice Address - Phone:806-803-9640
Practice Address - Fax:877-339-0645
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10674101YA0400X
TX3883251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)