Basic Information
Provider Information | |||||||||
NPI: | 1881744019 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOYT-ROGERS | ||||||||
FirstName: | LYNNA | ||||||||
MiddleName: | KAY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M ED | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOYT | ||||||||
OtherFirstName: | LYNNA | ||||||||
OtherMiddleName: | K | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M ED | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1400 WALLACE BLVD | ||||||||
Address2: |   | ||||||||
City: | AMARILLO | ||||||||
State: | TX | ||||||||
PostalCode: | 791061708 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8063545620 | ||||||||
FaxNumber: | 8063513783 | ||||||||
Practice Location | |||||||||
Address1: | 1400 WALLACE BLVD | ||||||||
Address2: |   | ||||||||
City: | AMARILLO | ||||||||
State: | TX | ||||||||
PostalCode: | 791061708 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8063545620 | ||||||||
FaxNumber: | 8063513783 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/11/2007 | ||||||||
LastUpdateDate: | 06/03/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 13188 | TX | Y |   | Behavioral Health & Social Service Providers | Counselor |   |
ID Information
ID | Type | State | Issuer | Description | 026970602 | 05 | TX |   | MEDICAID | 115530100 | 01 |   | COMPCARE | OTHER | 026970601 | 05 | TX |   | MEDICAID | 3275LC | 01 |   | BCBS | OTHER | 026970604 | 05 | TX |   | MEDICAID | 200271770 A | 05 | OK |   | MEDICAID | 000771199 | 01 |   | AETNA | OTHER | 03230384 | 05 | NM |   | MEDICAID | 026970605 | 05 | TX |   | MEDICAID |