Provider Demographics
NPI:1013581966
Name:MIMS, LINDSAY PEARL (LMHC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:PEARL
Last Name:MIMS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16409 CASTILE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2425
Mailing Address - Country:US
Mailing Address - Phone:912-674-4820
Mailing Address - Fax:
Practice Address - Street 1:16409 CASTILE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2425
Practice Address - Country:US
Practice Address - Phone:912-674-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health