Provider Demographics
NPI:1649749482
Name:LYNES, ANDREW THOMAS (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:LYNES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19667 CUMBERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-8049
Mailing Address - Country:US
Mailing Address - Phone:208-494-4094
Mailing Address - Fax:
Practice Address - Street 1:19667 CUMBERLAND WAY
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-8049
Practice Address - Country:US
Practice Address - Phone:208-494-4094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-22
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional