Provider Demographics
NPI:1174792097
Name:LYNCH, TIMOTHY RICHARD
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RICHARD
Last Name:LYNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:RICHARD
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:28241 PASEO EL SIENA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4500
Mailing Address - Country:US
Mailing Address - Phone:949-481-1025
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL, CAMP PENDLETON BLDG H100
Practice Address - Street 2:ATTENTION: CODE 094
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:210-496-8050
Practice Address - Fax:210-496-8970
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1722103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical