MEDICARE: LYNDZ SIMPSON-REBLIN 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	LPC-21023	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC-21023	OTHER	AZ	ARIZONA BOARD OF BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1629428420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDZ SIMPSON-REBLIN LPC

Provider Business Mailing Address
First Line	:	16835 W ABERDEEN DR
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-6870
Country	:	US
Telephone Number	:	623-451-1532
Fax Number	:

Provider Business Practice Location Address
First Line	:	14040 N CAVE CREEK RD STE 108
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-6117
Country	:	US
Telephone Number	:	602-358-7073
Fax Number	:	888-927-0409

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	12/18/2023

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