Staten, Lydia M.
Staten, Lydia M. is an sole proprietor health care provider with primary practice located at 1225 N West St , Jackson MS 39202-2056. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Staten, Lydia M. can be contacted via phone (601) 540-7105.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | C0715 | Mississippi |
Profile Details
| NPI number | 1679788616 |
|---|---|
| LBN Legal business name | Staten, Lydia M. |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 12th, 2007 |
| Last updated | May 25th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679788616 | NPPES |
| Mississippi | MEDICAID | 00120550 |
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