Provider Demographics
NPI:1679694046
Name:STALNAKER, LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:STALNAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 30TH AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-1818
Mailing Address - Country:US
Mailing Address - Phone:228-863-7358
Mailing Address - Fax:228-863-9325
Practice Address - Street 1:1105 30TH AVE
Practice Address - Street 2:STE 202
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-1818
Practice Address - Country:US
Practice Address - Phone:228-863-7358
Practice Address - Fax:228-863-9325
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC22121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical