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1013024454

NPI Code Detail

MEDICARE: MS. LYDIA ALPHA MABBITT LPC

MEDICARE: MS. LYDIA ALPHA MABBITT LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2000158656	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	431116734	OTHER		EAP INTERFACE
2	431116734	OTHER		EAP WELLPOINT
3	9877	OTHER	MO	FEI BEHAVIORAL
4	1013024454	OTHER		BLUE CROSS BLUE SHIELD
5	431116734	OTHER		EAP PEOPLE RESOURCES
6	2613	OTHER	MO	EAP IMPACT
7	11784624	OTHER	MO	CAQH
8	431116734	OTHER		EAP CERIDIAN
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	890435	OTHER	MO	HEALTHLINK PPO

General Provider Information

NPI Number	:	1013024454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYDIA ALPHA MABBITT LPC

Provider Business Mailing Address
First Line	:	PO BOX 280
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63902-0280
Country	:	US
Telephone Number	:	573-686-1200
Fax Number	:	573-686-1029

Provider Business Practice Location Address
First Line	:	3001 WARRIOR LN
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-8685
Country	:	US
Telephone Number	:	573-686-1200
Fax Number	:	573-686-1029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	04/21/2009

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Directions to “ MS. LYDIA ALPHA MABBITT LPC” Practice Location

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