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Individual

MRS. LYNN T KHANUJA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, LPC, OTR/L

Contact information

Practice address
3001 WARRIOR LN, POPLAR BLUFF, MO 63901-8685
(573) 686-1200
(573) 686-1029
Mailing address
PO BOX 280, POPLAR BLUFF, MO 63902-0280
(573) 686-1200
(573) 686-1029

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
20030322241
MO
101YP2500X
Professional Counselor
2003032241
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000450401
BLUE CROSS BLUE SHIELD
01
11514082
CAQH
01
2258
EAP IMPACT
01
431116734
EAP INTERFACE
05
475106027
MO
05
495106007
MO
Enumeration date
07/17/2007
Last updated
01/21/2009
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