Provider Demographics
NPI:1760880165
Name:TIMNEY, LAUREN (LMHC MS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TIMNEY
Suffix:
Gender:F
Credentials:LMHC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 N COURTENAY PKWY STE L
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4463
Mailing Address - Country:US
Mailing Address - Phone:321-978-5122
Mailing Address - Fax:
Practice Address - Street 1:11555 CENTRAL PKWY
Practice Address - Street 2:SUITE 704
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2691
Practice Address - Country:US
Practice Address - Phone:904-704-2527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLT500521828670103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1902239270Medicaid