Basic Information
Provider Information | |||||||||
NPI: | 1952799934 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BATISTA | ||||||||
FirstName: | LINDSEY | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BINGHAM | ||||||||
OtherFirstName: | LINDSEY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | SSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1161 N MURDOCK DR APT B | ||||||||
Address2: |   | ||||||||
City: | PLEASANT GROVE | ||||||||
State: | UT | ||||||||
PostalCode: | 840628957 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8018298912 | ||||||||
FaxNumber: | 8013730639 | ||||||||
Practice Location | |||||||||
Address1: | 3319 N UNIVERSITY AVE STE 100 | ||||||||
Address2: |   | ||||||||
City: | PROVO | ||||||||
State: | UT | ||||||||
PostalCode: | 846044447 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8013560014 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/29/2014 | ||||||||
LastUpdateDate: | 10/27/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/27/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 8773061-3501 | UT | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.