Provider Demographics
NPI:1922171859
Name:HARRIS, LYNN ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1592
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-1592
Mailing Address - Country:US
Mailing Address - Phone:970-577-0452
Mailing Address - Fax:970-577-9517
Practice Address - Street 1:356 E. ELKHORN AVE.
Practice Address - Street 2:SUITE 9
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517
Practice Address - Country:US
Practice Address - Phone:970-577-0452
Practice Address - Fax:970-577-9517
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY2745103TC0700X
KS1151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO116514OtherNATIONAL REGISTER
CO669484OtherPROVIDER ID
CO545238Medicare ID - Type UnspecifiedINDIVIDUAL
CO545218Medicare ID - Type UnspecifiedGROUP