Provider Demographics
NPI:1629201090
Name:LYNCH, LOUIS TYRONE
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:TYRONE
Last Name:LYNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 EL CENTRO FAMILIAR BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4502
Mailing Address - Country:US
Mailing Address - Phone:505-212-7395
Mailing Address - Fax:505-877-3533
Practice Address - Street 1:1710 EL CENTRO FAMILIAR BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4502
Practice Address - Country:US
Practice Address - Phone:505-212-7395
Practice Address - Fax:505-877-3533
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator