Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LSW3743 | TN |
NPI | 1003072539 |
---|---|
Provider Name | Mr. Lyndell B Stich |
First Address | Nashville, TN 37212-3701 |
Second Address | Nashville, TN 37212-3701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 04/08/2008 |