Provider Demographics
NPI:1245598499
Name:LYNDA S. WALLS, PH.D., INC.
Entity type:Organization
Organization Name:LYNDA S. WALLS, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-536-8095
Mailing Address - Street 1:13018 VIBURNUM DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1144
Mailing Address - Country:US
Mailing Address - Phone:904-536-8095
Mailing Address - Fax:
Practice Address - Street 1:931 CASSAT AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4857
Practice Address - Country:US
Practice Address - Phone:904-388-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4887103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty