Basic Information
| Provider Information | |||||||||
| NPI: | 1225162571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VESTAL | ||||||||
| FirstName: | LYNNE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1239 73RD STREET | ||||||||
| Address2: | SUITE J | ||||||||
| City: | WINDSOR HEIGHTS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152678899 | ||||||||
| FaxNumber: | 5152235572 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193536963 | ||||||||
| FaxNumber: | 3193562587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 00815 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.