Provider Demographics
NPI:1588901789
Name:KALLMAN, LYNELL BETH (LAC)
Entity type:Individual
Prefix:
First Name:LYNELL
Middle Name:BETH
Last Name:KALLMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:520 WASHINGTON STREET, SUITE C
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-0254
Mailing Address - Country:US
Mailing Address - Phone:785-243-4164
Mailing Address - Fax:785-243-4614
Practice Address - Street 1:520 WASHINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2121
Practice Address - Country:US
Practice Address - Phone:785-243-4164
Practice Address - Fax:785-243-4164
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200363150AMedicaid