Provider Demographics
NPI:1578621454
Name:LYNN, TAMMY REANE' (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:REANE'
Last Name:LYNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 842
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-0842
Mailing Address - Country:US
Mailing Address - Phone:865-207-0541
Mailing Address - Fax:
Practice Address - Street 1:241 SOUTH CALDERWOOD STREET
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701
Practice Address - Country:US
Practice Address - Phone:865-207-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000044281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4090613OtherBLUE CROSS BLUE SHIELD
TN3927072Medicare ID - Type Unspecified