Healthcare Provider Details

I. General information

NPI: 1184857187
Provider Name (Legal Business Name): LYNN M. HELDER, PH.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ARAPAHO AVE
ST AUGUSTINE FL
32084-4203
US

IV. Provider business mailing address

1201 ARAPAHO AVE
ST AUGUSTINE FL
32084-4203
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-7000
  • Fax: 904-794-5111
Mailing address:
  • Phone: 904-794-7000
  • Fax: 904-794-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY4997
License Number StateFL

VIII. Authorized Official

Name: DR. LYNN MARIE HELDER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 904-794-7000