Provider Demographics
NPI:1437217643
Name:LYNN E FLINT WIDDIFIELD
Entity Type:Organization
Organization Name:LYNN E FLINT WIDDIFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SOLE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLINT WIDDIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP ATR BC
Authorized Official - Phone:308-381-0787
Mailing Address - Street 1:1811 W 2ND ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5413
Mailing Address - Country:US
Mailing Address - Phone:308-381-0787
Mailing Address - Fax:308-381-4632
Practice Address - Street 1:1811 W 2ND ST
Practice Address - Street 2:SUITE 310
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5464
Practice Address - Country:US
Practice Address - Phone:308-381-0787
Practice Address - Fax:308-381-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025443500Medicaid