Provider Demographics
NPI:1013690957
Name:QUINN, LYDIA ARTEEL (LSW)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ARTEEL
Last Name:QUINN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W HEARTWOOD CT APT A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5254
Mailing Address - Country:US
Mailing Address - Phone:812-345-8405
Mailing Address - Fax:
Practice Address - Street 1:1950 DOCTORS PARK DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2376
Practice Address - Country:US
Practice Address - Phone:812-807-1579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011552A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health