Provider Demographics
NPI:1316372022
Name:ATHANASOPULOS, LYN MARIE
Entity Type:Individual
Prefix:MRS
First Name:LYN
Middle Name:MARIE
Last Name:ATHANASOPULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LYN
Other - Middle Name:MARIE
Other - Last Name:ALLRED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 W. 11TH STREET
Mailing Address - Street 2:FAMILY SOLUTIONS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-776-0497
Mailing Address - Fax:541-282-0359
Practice Address - Street 1:510 W. 11TH STREET
Practice Address - Street 2:FAMILY SOLUTIONS
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-776-0497
Practice Address - Fax:541-282-0359
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst