Provider Demographics
NPI:1912256504
Name:GOMEZ, LINDSAY K (MH17282)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:K
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MH17282
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:KAY
Other - Last Name:VAN SCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARRIED 2013
Mailing Address - Street 1:8260 COLLEGE PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5105
Mailing Address - Country:US
Mailing Address - Phone:239-246-8774
Mailing Address - Fax:
Practice Address - Street 1:8260 COLLEGE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5105
Practice Address - Country:US
Practice Address - Phone:239-246-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health