Provider Demographics
NPI:1679393029
Name:WORMELL, LINDSEY MARIE
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:WORMELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 MOBILE TRL W
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9253
Mailing Address - Country:US
Mailing Address - Phone:231-838-9837
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 392
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-0392
Practice Address - Country:US
Practice Address - Phone:231-268-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician