Provider Demographics
NPI:1760728240
Name:DRLMHENDERSONLLC
Entity Type:Organization
Organization Name:DRLMHENDERSONLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-422-5368
Mailing Address - Street 1:551 BAYWOOD DR S
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2012
Mailing Address - Country:US
Mailing Address - Phone:727-422-5368
Mailing Address - Fax:727-724-4482
Practice Address - Street 1:28870 US HIGHWAY 19 N STE 300
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4328
Practice Address - Country:US
Practice Address - Phone:727-422-5368
Practice Address - Fax:727-724-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8343314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFN118AOtherMEDICARE PTAN