Provider Demographics
NPI:1417398835
Name:POWELL, LYNN H (LMHC, CTRS)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:H
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMHC, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 SOUTHSIDE BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5492
Mailing Address - Country:US
Mailing Address - Phone:904-566-9256
Mailing Address - Fax:904-595-5199
Practice Address - Street 1:4540 SOUTHSIDE BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5492
Practice Address - Country:US
Practice Address - Phone:904-566-9256
Practice Address - Fax:904-595-5199
Is Sole Proprietor?:No
Enumeration Date:2013-07-14
Last Update Date:2013-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional