Provider Demographics
NPI:1689928574
Name:LYNCH, MICHELE (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S WASHINGTON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2866
Mailing Address - Country:US
Mailing Address - Phone:208-883-9927
Mailing Address - Fax:208-883-9935
Practice Address - Street 1:127 S WASHINGTON ST STE 5
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2866
Practice Address - Country:US
Practice Address - Phone:509-592-8268
Practice Address - Fax:208-906-8601
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health