=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669622460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARY K. LYNDELL, PSY.D., P. C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2008
-----------------------------------------------------
Last Update Date | 09/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 E NORTH AVE SUITE 101
-----------------------------------------------------
City | BELTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64012-9908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-318-3537
-----------------------------------------------------
Fax | 816-318-3538
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 365
-----------------------------------------------------
City | BELTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64012-0365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-318-3537
-----------------------------------------------------
Fax | 816-318-3538
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MARY K. LYNDELL
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 816-318-3537
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 01873
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------