Provider Demographics
NPI:1235508037
Name:GRESHAM, LYNN A (LPC (MED))
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:A
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:LPC (MED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 PERKINS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4237
Mailing Address - Country:US
Mailing Address - Phone:225-803-2046
Mailing Address - Fax:225-803-2046
Practice Address - Street 1:6555 PERKINS RD STE 300
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4237
Practice Address - Country:US
Practice Address - Phone:225-803-2046
Practice Address - Fax:225-803-2046
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional