Provider Demographics
NPI:1033388566
Name:LYNCH, RONALD JAMES (MC, LPC, LISAC, CSAT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MC, LPC, LISAC, CSAT
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:ANN
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8659 W LARIAT LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4630
Mailing Address - Country:US
Mailing Address - Phone:623-877-8000
Mailing Address - Fax:623-877-6424
Practice Address - Street 1:8659 W LARIAT LN
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-4630
Practice Address - Country:US
Practice Address - Phone:623-877-8000
Practice Address - Fax:623-877-6424
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11817101YA0400X
AZLPC-12197101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)