Provider Demographics
NPI:1285679340
Name:LINZEY FAISON MENTAL HEALTH ASSOCIATES INC
Entity Type:Organization
Organization Name:LINZEY FAISON MENTAL HEALTH ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LINZEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAISON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, CNS
Authorized Official - Phone:850-663-4347
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324-0486
Mailing Address - Country:US
Mailing Address - Phone:850-663-4347
Mailing Address - Fax:850-663-4727
Practice Address - Street 1:501 S BOLIVAR ST
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324-1347
Practice Address - Country:US
Practice Address - Phone:850-663-4347
Practice Address - Fax:850-663-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL637562364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301562900Medicaid
FLU7191AMedicare NSC
FLY4456Medicare PIN