Provider Demographics
NPI:1609233691
Name:LYNCH, KYLIE
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:LYNCH
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 1:333 W MAIN ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6326
Mailing Address - Country:US
Mailing Address - Phone:580-276-7576
Mailing Address - Fax:866-777-7906
Practice Address - Street 1:333 W MAIN ST
Practice Address - Street 2:SUITE 260
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6326
Practice Address - Country:US
Practice Address - Phone:580-276-7576
Practice Address - Fax:866-777-7906
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor