Provider Demographics
NPI:1114003308
Name:FLINT WIDDIFIELD, LYNN ELLEN (LIMHP ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ELLEN
Last Name:FLINT WIDDIFIELD
Suffix:
Gender:F
Credentials:LIMHP ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 WEST 2ND ST
Mailing Address - Street 2:SUITE 310 TIER ONE BANK BLDG
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803
Mailing Address - Country:US
Mailing Address - Phone:308-381-0787
Mailing Address - Fax:
Practice Address - Street 1:1811 WEST 2ND ST
Practice Address - Street 2:SUITE 310 TIER ONE BANK BLDG
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-381-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
205404547OtherFEDERAL TAX ID N