Provider Demographics
NPI:1336638097
Name:MIRON, LYNSEY R (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:LYNSEY
Middle Name:R
Last Name:MIRON
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 BLACKSHIRE PATH
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:651-455-4811
Practice Address - Street 1:5838 BLACKSHIRE PATH
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076
Practice Address - Country:US
Practice Address - Phone:651-497-4432
Practice Address - Fax:651-455-4811
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6193103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical