Provider Demographics
NPI:1972987741
Name:DAILEY, LIDIA LYNETTE (LCDC)
Entity type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:LYNETTE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:LCDC
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 33046
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79120-3046
Mailing Address - Country:US
Mailing Address - Phone:806-471-3249
Mailing Address - Fax:877-339-0645
Practice Address - Street 1:706 N POLK ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5248
Practice Address - Country:US
Practice Address - Phone:806-803-9640
Practice Address - Fax:877-339-0645
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3883-4817276400000X, 324500000X, 3245S0500X, 101YA0400X
TX10674101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children