Provider Demographics
NPI:1295481604
Name:LONE CYPRESS BEHAVIORAL HEALTH , PLLC
Entity type:Organization
Organization Name:LONE CYPRESS BEHAVIORAL HEALTH , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, PMHNP-BC
Authorized Official - Phone:360-251-0898
Mailing Address - Street 1:PO BOX 1532
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-1532
Mailing Address - Country:US
Mailing Address - Phone:360-251-0898
Mailing Address - Fax:360-251-0863
Practice Address - Street 1:203 W PATISON ST STE B
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339-8701
Practice Address - Country:US
Practice Address - Phone:360-251-0898
Practice Address - Fax:360-251-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid