Provider Demographics
NPI:1962682971
Name:ELLIOTT, LYNDSAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LYNDSAY
Middle Name:
Last Name:ELLIOTT
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 1:1550 BAYSIDE DR
Mailing Address - Street 2:STE 6
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625
Mailing Address - Country:US
Mailing Address - Phone:888-917-7924
Mailing Address - Fax:888-830-8285
Practice Address - Street 1:1550 BAYSIDE DR
Practice Address - Street 2:STE 6
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625
Practice Address - Country:US
Practice Address - Phone:888-917-7924
Practice Address - Fax:888-830-8285
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21342103T00000X, 103TC0700X, 103TC2200X, 103TF0200X, 103TH0004X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth