Provider Demographics
NPI:1265864938
Name:WATERS, LYNN N (LMHC, CRC, LPC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:N
Last Name:WATERS
Suffix:
Gender:F
Credentials:LMHC, CRC, LPC
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 1190
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32591-1190
Mailing Address - Country:US
Mailing Address - Phone:850-712-4039
Mailing Address - Fax:
Practice Address - Street 1:5101 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8918
Practice Address - Country:US
Practice Address - Phone:850-607-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1957101YM0800X
FLMH12465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651167924OtherCOUNSELOR