Provider Demographics
NPI:1093843831
Name:SANTIAGO, LYNNE ANGELA (LMHC)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:ANGELA
Last Name:SANTIAGO
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 1:1304 S DE SOTO AVE
Mailing Address - Street 2:#304
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3146
Mailing Address - Country:US
Mailing Address - Phone:813-258-4258
Mailing Address - Fax:
Practice Address - Street 1:1304 S DE SOTO AVE
Practice Address - Street 2:#304
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3146
Practice Address - Country:US
Practice Address - Phone:813-258-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health