MEDICARE: MR. COURTNEY TAYLOR LYMAN

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	225400000X	Rehabilitation Practitioner
2	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639513278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COURTNEY TAYLOR LYMAN

Provider Business Mailing Address
First Line	:	50 S STATE ST
Second Line	:
City	:	LA VERKIN
State	:	UT
Zip	:	84745-5443
Country	:	US
Telephone Number	:	877-698-4968
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 S STATE ST
Second Line	:
City	:	LA VERKIN
State	:	UT
Zip	:	84745-5443
Country	:	US
Telephone Number	:	877-698-4968
Fax Number	:

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	01/27/2020

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