Provider Demographics
NPI:1851319495
Name:LIGHTFOOT, LYNN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:E
Last Name:LIGHTFOOT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 N DAVIS HWY
Mailing Address - Street 2:SUITE 2-E
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2782
Mailing Address - Country:US
Mailing Address - Phone:850-477-9441
Mailing Address - Fax:850-479-2821
Practice Address - Street 1:4551 N DAVIS HWY
Practice Address - Street 2:SUITE 2-E
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2782
Practice Address - Country:US
Practice Address - Phone:850-477-9441
Practice Address - Fax:850-479-2821
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004939103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59430Medicare ID - Type UnspecifiedPROVIDER