Healthcare Provider Details

I. General information

NPI: 1871252825
Provider Name (Legal Business Name): LYNDEN COUNSELING COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 02/16/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 3RD ST
LYNDEN WA
98264-1408
US

IV. Provider business mailing address

105 3RD ST
LYNDEN WA
98264-1408
US

V. Phone/Fax

Practice location:
  • Phone: 830-734-4000
  • Fax:
Mailing address:
  • Phone: 830-734-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELLY COOPER
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LH61228753
Phone: 830-734-4000