Provider Demographics
NPI:1376878645
Name:LYNCH, TRYVON
Entity Type:Individual
Prefix:
First Name:TRYVON
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BST
Mailing Address - Street 2:9
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541
Mailing Address - Country:US
Mailing Address - Phone:510-706-6014
Mailing Address - Fax:
Practice Address - Street 1:1201 B ST
Practice Address - Street 2:9
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2939
Practice Address - Country:US
Practice Address - Phone:510-706-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)