Provider Demographics
NPI:1326640624
Name:LYNCH, JILL (LMHC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5679 NE 61ST AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34488-1243
Mailing Address - Country:US
Mailing Address - Phone:609-969-3377
Mailing Address - Fax:
Practice Address - Street 1:5679 NE 61ST AVENUE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34488-1243
Practice Address - Country:US
Practice Address - Phone:609-969-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty