Provider Demographics
NPI:1538634704
Name:MYKYTYN, LYNN MARIE WOO
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE WOO
Last Name:MYKYTYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 104TH CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4503
Mailing Address - Country:US
Mailing Address - Phone:612-501-4085
Mailing Address - Fax:
Practice Address - Street 1:5851 DULUTH ST STE 316
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3957
Practice Address - Country:US
Practice Address - Phone:612-202-8703
Practice Address - Fax:612-241-1943
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health