Healthcare Provider Details

I. General information

NPI: 1306853494
Provider Name (Legal Business Name): LYNN ELLEN SCARBROUGH M.A., LPC, ACR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12416 HYMEADOW DR STE 207
AUSTIN TX
78750-2283
US

IV. Provider business mailing address

1010 W JASPER DR STE 9
KILLEEN TX
76542-1328
US

V. Phone/Fax

Practice location:
  • Phone: 877-519-1144
  • Fax: 254-519-1155
Mailing address:
  • Phone: 254-519-1144
  • Fax: 254-519-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19039
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: