Provider Demographics
NPI:1649381872
Name:LINDSEY, LYNNEA EILEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNEA
Middle Name:EILEEN
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LYNNEA
Other - Middle Name:EILEEN
Other - Last Name:LINDSEY-PENGELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1661 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4113
Mailing Address - Country:US
Mailing Address - Phone:541-343-3433
Mailing Address - Fax:541-343-2218
Practice Address - Street 1:1661 HIGH ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4113
Practice Address - Country:US
Practice Address - Phone:541-343-3433
Practice Address - Fax:541-343-2218
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1246103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR062ZBBTDAMedicare UPIN