Provider Demographics
NPI:1073600060
Name:MCANDREWS, LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:MCANDREWS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W FRONT ST STE 415
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2279
Mailing Address - Country:US
Mailing Address - Phone:231-929-9777
Mailing Address - Fax:
Practice Address - Street 1:310 W FRONT ST STE 415
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2279
Practice Address - Country:US
Practice Address - Phone:231-929-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M94120Medicare ID - Type UnspecifiedMEDICARE
MIS98016Medicare UPIN