Provider Demographics
NPI:1114253549
Name:CUNNINGHAM, LYNN ASHLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ASHLEY
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4579 LACLEDE AVE
Mailing Address - Street 2:# 443
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2103
Mailing Address - Country:US
Mailing Address - Phone:314-367-0403
Mailing Address - Fax:314-367-0178
Practice Address - Street 1:8 W PINE CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2110
Practice Address - Country:US
Practice Address - Phone:314-367-0403
Practice Address - Fax:314-367-0178
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004017382103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)