Provider Demographics
NPI:1174646707
Name:RUTHERFORD, LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8813 CLEARBROOK TRL
Mailing Address - Street 2:UNIT B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-4624
Mailing Address - Country:US
Mailing Address - Phone:512-454-2284
Mailing Address - Fax:512-454-2284
Practice Address - Street 1:5617 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1102
Practice Address - Country:US
Practice Address - Phone:512-454-2284
Practice Address - Fax:512-454-2284
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional