Provider Demographics
NPI:1457858789
Name:CONNER, LYNN ANSEL (MDIV,MFCS,LMFT)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:ANSEL
Last Name:CONNER
Suffix:
Gender:M
Credentials:MDIV,MFCS,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 N PARK PL NE STE 113
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6222
Mailing Address - Country:US
Mailing Address - Phone:319-519-9897
Mailing Address - Fax:
Practice Address - Street 1:5300 N PARK PL NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6234
Practice Address - Country:US
Practice Address - Phone:319-519-9897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000293106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist