Provider Demographics
NPI:1164655445
Name:RICE BRINKWORTH, LYNELL MAR (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LYNELL
Middle Name:MAR
Last Name:RICE BRINKWORTH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 QUINCY ST STE 102A
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8230
Mailing Address - Country:US
Mailing Address - Phone:605-381-5277
Mailing Address - Fax:
Practice Address - Street 1:623 QUINCY ST STE 102A
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8230
Practice Address - Country:US
Practice Address - Phone:605-381-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47324106H00000X
SDLMFT1209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist