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General NPI Number Information
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NPI Number | 1265855712
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Entity Type | Organization
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Legal Business Name | LYNN M. THEBO, LCSW, PLLC
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 3109 SOUTHWEST BLVD. STE. B
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City | SAN ANGELO
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State | TX
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Zip | 76904
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Country | US
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Telephone | 325-939-7641
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 SOUTHWEST BLVD. STE. B
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City | SAN ANGELO
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State | TX
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Zip | 76904
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Country | US
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Telephone | 325-939-7641
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Fax |
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Authorized Official
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Title or Position | OWNER/LCSW
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Name | MS. LYNN MARIE THEBO
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Credential | LCSW
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Telephone | 325-939-7641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 50867
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License Number State | TX
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