Provider Demographics
NPI:1902826878
Name:NIX, LYNLEY S
Entity Type:Individual
Prefix:
First Name:LYNLEY
Middle Name:S
Last Name:NIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2576 BARRON CT
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1280
Mailing Address - Country:US
Mailing Address - Phone:850-833-3872
Mailing Address - Fax:850-833-3873
Practice Address - Street 1:5150 BAYOU BLVD
Practice Address - Street 2:STE 1N
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2158
Practice Address - Country:US
Practice Address - Phone:850-833-3872
Practice Address - Fax:850-833-3873
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker