Provider Demographics
NPI:1558405910
Name:PUJOL, LYNETTE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:A
Last Name:PUJOL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LYNETTE
Other - Middle Name:A
Other - Last Name:MENEFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:24518 BUCK CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2250
Mailing Address - Country:US
Mailing Address - Phone:484-343-0455
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-5792
Practice Address - Fax:210-916-5102
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008510L103T00000X, 103TC0700X, 103TH0100X
NMPSY1561103TC0700X
NMRXC077103TC0700X
TX36048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA894280Medicare ID - Type Unspecified