=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134726060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYNK WELL SPRING SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2020
-----------------------------------------------------
Last Update Date | 05/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2424 W HOLCOMBE BLVD STE 204
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-1935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-280-6359
-----------------------------------------------------
Fax | 832-581-4309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10819 ASHLAND BRIDGE LN
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77498-5045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-415-3127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NP
-----------------------------------------------------
Name | MRS. LILIAN IKE
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 281-415-3127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------