Provider Demographics
NPI:1295040319
Name:LYNN, DENISE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:LYNN
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 1:1941 SOURWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2951
Mailing Address - Country:US
Mailing Address - Phone:727-743-2805
Mailing Address - Fax:727-733-2806
Practice Address - Street 1:2723 BELLE HAVEN DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1002
Practice Address - Country:US
Practice Address - Phone:727-743-2805
Practice Address - Fax:727-733-2806
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1381103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1381OtherLMHC