Active NPI
Lynn Marie Thebo, LCSW
- Clinical Social Worker
- San Angelo, TX
National Provider Identifier
1487077459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 50867
- Practice address
- 3109 Southwest Blvd.
Ste. B
San Angelo, TX 76904 - Phone
- (325) 939-7641
- Fax
- (325) 939-7641
- NPI assigned
- Jan 28, 2014
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 50867 | TX | Primary |
Addresses
Primary practice location
3109 Southwest Blvd.
Ste. B
San Angelo, TX 76904
Mailing address
3109 Southwest Blvd
Ste. B
San Angelo, TX 76904
Phone (325) 939-7641
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 348231ZGGP | Other | TX | MEDICARE PTAN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50867 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456185600000",
"number": "1487077459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3109 SOUTHWEST BLVD",
"address_2": "STE. B",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "76904",
"telephone_number": "325-939-7641",
"fax_number": "325-939-7641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3109 SOUTHWEST BLVD.",
"address_2": "STE. B",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "76904",
"telephone_number": "325-939-7641",
"fax_number": "325-939-7641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEBO",
"first_name": "LYNN",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-28",
"last_updated": "2016-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "50867",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "348231ZGGP",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Angelo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.