Healthcare Provider Details

I. General information

NPI: 1962682971
Provider Name (Legal Business Name): LYNDSAY ELLIOTT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 LIBERTY PIKE # 229-300
FRANKLIN TN
37067-5604
US

IV. Provider business mailing address

1550 BAYSIDE DR
CORONA DEL MAR CA
92625-1711
US

V. Phone/Fax

Practice location:
  • Phone: 615-753-7888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3891
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21342
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21342
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY21342
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY21342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: