Healthcare Provider Details

I. General information

NPI: 1891812657
Provider Name (Legal Business Name): LYNN MARIE VEACH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E 4TH B1
ROSWELL NM
88201
US

IV. Provider business mailing address

PO BOX 3491 424 E4 B1
ROSWELL NM
88202-3491
US

V. Phone/Fax

Practice location:
  • Phone: 575-551-8335
  • Fax:
Mailing address:
  • Phone: 575-551-8335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number977
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: