Provider Demographics
NPI:1184857187
Name:LYNN M. HELDER, PH.D., P.A.
Entity Type:Organization
Organization Name:LYNN M. HELDER, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HELDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-794-7000
Mailing Address - Street 1:1201 ARAPAHO AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4203
Mailing Address - Country:US
Mailing Address - Phone:904-794-7000
Mailing Address - Fax:904-794-5111
Practice Address - Street 1:1201 ARAPAHO AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4203
Practice Address - Country:US
Practice Address - Phone:904-794-7000
Practice Address - Fax:904-794-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4997103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59528CMedicare UPIN