MEDICARE: MS. YLANDA LINDSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		AZ

General Provider Information

NPI Number	:	1164187480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YLANDA LINDSEY

Provider Business Mailing Address
First Line	:	4688 W TANGERINE RD APT 4108
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658-4871
Country	:	US
Telephone Number	:	864-809-6447
Fax Number	:

Provider Business Practice Location Address
First Line	:	13210 W VAN BUREN ST
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85338-1164
Country	:	US
Telephone Number	:	623-259-5800
Fax Number	:	623-259-5858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	11/02/2021

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