Provider Demographics
NPI:1215226295
Name:LYNCH, MICHAEL TIMOTHY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:LYNCH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 MANLIUS CENTER RD
Mailing Address - Street 2:TRILLIUM FITNESS CENTER
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2999
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 MANLIUS CENTER RD
Practice Address - Street 2:TRILLIUM FITNESS CENTER
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2999
Practice Address - Country:US
Practice Address - Phone:315-463-9355
Practice Address - Fax:315-463-9354
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist