Healthcare Provider Details

I. General information

NPI: 1629139993
Provider Name (Legal Business Name): LYNETTE M SEXTON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S DIAMOND ST
CENTRALIA WA
98531-3817
US

IV. Provider business mailing address

155 EMERALD HILL RD
CHEHALIS WA
98532-8931
US

V. Phone/Fax

Practice location:
  • Phone: 360-918-3009
  • Fax:
Mailing address:
  • Phone: 360-918-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00008498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: