MEDICARE: LYDIAS SMALL UNIQUE MINDS LLC

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	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1578335618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYDIAS SMALL UNIQUE MINDS LLC

Provider Business Mailing Address
First Line	:	509 GREENVILLE ST
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-3326
Country	:	US
Telephone Number	:	706-883-5801
Fax Number	:	706-416-2490

Provider Business Practice Location Address
First Line	:	312 RENDER ST
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-3418
Country	:	US
Telephone Number	:	706-883-5801
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LYDIA TIGGS
Credential	:
Telephone Number	:	706-883-5801

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	06/11/2026

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Directions to “LYDIAS SMALL UNIQUE MINDS LLC ” Practice Location

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