Provider Demographics
NPI:1982918124
Name:LT RESOURCES
Entity Type:Organization
Organization Name:LT RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:LIANE
Authorized Official - Last Name:HOORNSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:715-284-9477
Mailing Address - Street 1:409 COUNTY ROAD R
Mailing Address - Street 2:PO BOX 271
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-5129
Mailing Address - Country:US
Mailing Address - Phone:715-284-9477
Mailing Address - Fax:715-284-5547
Practice Address - Street 1:409 COUNTY ROAD R
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5129
Practice Address - Country:US
Practice Address - Phone:715-284-9477
Practice Address - Fax:715-284-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3117125251S00000X
WI15427131251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42254300Medicaid