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Individual

AMY L LYSTAD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S., LMHC, BCB

Contact information

Practice address
114 S. 5TH ST., ELMA, WA 98541
(360) 482-0244
Mailing address
PO BOX 1496, ELMA, WA 98541-1496
(360) 482-0244

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LH 60160513
WA

Other

Enumeration date
03/24/2010
Last updated
05/02/2012
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