Basic Information
| Provider Information | |||||||||
| NPI: | 1740596576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAYTON | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 ENTERPRISE DR | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680287943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022076533 | ||||||||
| FaxNumber: | 4026146174 | ||||||||
| Practice Location | |||||||||
| Address1: | 3308 SAMSON WAY | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681233234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027177681 | ||||||||
| FaxNumber: | 4022918806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1559 | NE | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.