Healthcare Provider Details

I. General information

NPI: 1497846547
Provider Name (Legal Business Name): LYNN LANGDALE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN LANGDALE B.A., M.A.

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 MACDONALD AVE SUITE 5
KEY WEST FL
33040
US

IV. Provider business mailing address

5450 MACDONALD AVE SUITE 5
KEY WEST FL
33040
US

V. Phone/Fax

Practice location:
  • Phone: 305-294-1277
  • Fax: 305-294-8927
Mailing address:
  • Phone: 305-294-1277
  • Fax: 305-294-8927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: