Provider Demographics
NPI:1326212168
Name:LYNCH, TERESA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:JEAN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3758
Mailing Address - Country:US
Mailing Address - Phone:989-615-5989
Mailing Address - Fax:
Practice Address - Street 1:1717 E SUGNET RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-3827
Practice Address - Country:US
Practice Address - Phone:989-615-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical