Healthcare Provider Details

I. General information

NPI: 1154943462
Provider Name (Legal Business Name): LYNDSAY BROOKS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/09/2020
Certification Date: 05/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 GUADALUPE ST
AUSTIN TX
78751-4223
US

IV. Provider business mailing address

3507 N LAMAR BLVD # 301528
AUSTIN TX
78705-1108
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-0381
  • Fax:
Mailing address:
  • Phone: 817-966-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30372
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number38314
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: