Provider Demographics
NPI:1376097675
Name:LYNCH, JERI (LAPC)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3304
Mailing Address - Country:US
Mailing Address - Phone:701-252-5586
Mailing Address - Fax:
Practice Address - Street 1:612 1ST AVE N
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-3304
Practice Address - Country:US
Practice Address - Phone:701-252-5586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND870-4-15-16A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional