Provider Demographics
NPI:1326321381
Name:LYNCH, MARTA GUEN (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:GUEN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:
Other - Last Name:FLISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5275
Mailing Address - Country:US
Mailing Address - Phone:573-814-6631
Mailing Address - Fax:573-814-6267
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-814-6631
Practice Address - Fax:573-814-6267
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011019096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1134125552Medicaid