Healthcare Provider Details

I. General information

NPI: 1285679340
Provider Name (Legal Business Name): LINZEY FAISON MENTAL HEALTH ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BOLIVAR ST
CHATTAHOOCHEE FL
32324-1347
US

IV. Provider business mailing address

PO BOX 486
CHATTAHOOCHEE FL
32324-0486
US

V. Phone/Fax

Practice location:
  • Phone: 850-663-4347
  • Fax: 850-663-4727
Mailing address:
  • Phone: 850-663-4347
  • Fax: 850-663-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberFL637562
License Number StateFL

VIII. Authorized Official

Name: MR. LINZEY R. FAISON
Title or Position: PRESIDENT
Credential: ARNP, CNS
Phone: 850-663-4347