Provider Demographics
NPI:1114937307
Name:LYNCH, KEVIN BRYAN (MDIV, LPC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRYAN
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 N CHURCH ST
Mailing Address - Street 2:PSYCHIATRIC ASSOCIATES OF SPARTANBURG, PA
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2712
Mailing Address - Country:US
Mailing Address - Phone:864-585-2214
Mailing Address - Fax:
Practice Address - Street 1:943 N CHURCH ST
Practice Address - Street 2:PSYCHIATRIC ASSOCIATES OF SPARTANBURG, PA
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2712
Practice Address - Country:US
Practice Address - Phone:864-585-2214
Practice Address - Fax:864-585-5608
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
SC2064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional