Provider Demographics
NPI:1316997802
Name:MCKIM, LYNN ARTHUR (MS)
Entity type:Individual
Prefix:MR
First Name:LYNN
Middle Name:ARTHUR
Last Name:MCKIM
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 W. FAIRFIELD DRIVE
Mailing Address - Street 2:PLAZA BLDG STE 301
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501
Mailing Address - Country:US
Mailing Address - Phone:850-434-6774
Mailing Address - Fax:850-434-6784
Practice Address - Street 1:1720 W FAIRFIELD DR
Practice Address - Street 2:PLAZA BLDG STE 301
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1052
Practice Address - Country:US
Practice Address - Phone:850-434-6774
Practice Address - Fax:850-434-6784
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL231873OtherHEALTHEASE - INDIVIDUAL
FL266591OtherHEALTHEASE - PRACTICE