Provider Demographics
NPI:1760676175
Name:CORELLA, LYNN WARD (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:WARD
Last Name:CORELLA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 BOW LN
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-2235
Mailing Address - Country:US
Mailing Address - Phone:352-769-1953
Mailing Address - Fax:
Practice Address - Street 1:2185 BOW LN
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-2235
Practice Address - Country:US
Practice Address - Phone:352-769-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LH-00010739101YM0800X
NM0102871101YM0800X
94607101YM0800X
FLMH17885101YP2500X
666309133V00000X
WALH00010739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered