Provider Demographics
NPI:1508315771
Name:LINCOLN, KYLE JORDAN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:JORDAN
Last Name:LINCOLN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WASHINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3516
Mailing Address - Country:US
Mailing Address - Phone:978-354-5953
Mailing Address - Fax:
Practice Address - Street 1:60 WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3516
Practice Address - Country:US
Practice Address - Phone:978-969-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MA12582-MH-CC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist