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General NPI Number Information
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NPI Number | 1982857934
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Entity Type | Individual
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Provider Name | LYNAE JOY OTTEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 1713 WOODWIND WAY
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City | VAN BUREN
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State | AR
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Zip | 72956-2044
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Country | US
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Telephone | 712-363-7942
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Fax |
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Provider Business Mailing Address
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Address Line | 1713 WOODWIND WAY
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City | VAN BUREN
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State | AR
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Zip | 72956-2044
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Country | US
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Telephone | 712-363-7942
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8233
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 082139
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5158-C
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License Number State | AR
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