Healthcare Provider Details

I. General information

NPI: 1861850562
Provider Name (Legal Business Name): LYNN A MCCORMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W 11TH ST
BIG SPRING TX
79720-2913
US

IV. Provider business mailing address

103 W 11TH ST
BIG SPRING TX
79720-2913
US

V. Phone/Fax

Practice location:
  • Phone: 432-517-4557
  • Fax: 806-894-3378
Mailing address:
  • Phone: 432-517-4557
  • Fax: 806-894-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70978
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70978
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: