Provider Demographics
NPI:1538316294
Name:LYNCH, KATHLEEN (MFC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N LOUISE ST UNIT 109
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4256
Mailing Address - Country:US
Mailing Address - Phone:818-298-3177
Mailing Address - Fax:
Practice Address - Street 1:540 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1120
Practice Address - Country:US
Practice Address - Phone:818-298-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist