Active NPI
Lynne Grace Davidson, MA, LPC
- Mental Health Counselor
- Rolla, MO
National Provider Identifier
1104006618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2006035744
- Practice address
- 1051 Kingshighway St
Rolla, MO 65401-2938 - Phone
- (573) 364-8511
- NPI assigned
- Nov 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2006035744 | MO | Primary |
Addresses
Primary practice location
1051 Kingshighway St
Rolla, MO 65401-2938
Mailing address
1051 Kingshighway St
Rolla, MO 65401-2938
Phone (573) 364-8511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006035744 | MO | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Missouri Behavioral Health Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Farmington, MO
- NPI 1982875407
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349136000000",
"number": "1104006618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1051 KINGSHIGHWAY ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654012938",
"telephone_number": "573-364-8511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1051 KINGSHIGHWAY ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654012938",
"telephone_number": "573-364-8511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "LYNNE",
"middle_name": "GRACE",
"credential": "MA, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-13",
"last_updated": "2012-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "2006035744",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.