Provider Demographics
NPI:1528139805
Name:PELLIKAN, LYDIA LAUREL (MDIV)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:LAUREL
Last Name:PELLIKAN
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 HIGHLAND OAKS ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-3616
Mailing Address - Country:US
Mailing Address - Phone:903-537-2627
Mailing Address - Fax:
Practice Address - Street 1:4525 LEMMON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2145
Practice Address - Country:US
Practice Address - Phone:214-526-4525
Practice Address - Fax:214-520-6468
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral