Provider Demographics
NPI:1407958275
Name:BOATWRIGHT, LYNN KAY (PHD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:KAY
Last Name:BOATWRIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MOUNTAIN CREEK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4501
Mailing Address - Country:US
Mailing Address - Phone:423-870-0036
Mailing Address - Fax:423-870-0706
Practice Address - Street 1:901 MOUNTAIN CREEK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-4501
Practice Address - Country:US
Practice Address - Phone:423-870-0036
Practice Address - Fax:423-870-0706
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1070103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0172508OtherBLUE CROSS BLUE SHIELD
TN0172508OtherBLUE CROSS BLUE SHIELD