Provider Demographics
NPI:1689979395
Name:LYNCH, AMBER DAWN (BHRS)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DAWN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30945 SKY LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-7750
Mailing Address - Country:US
Mailing Address - Phone:918-647-9674
Mailing Address - Fax:
Practice Address - Street 1:320 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4212
Practice Address - Country:US
Practice Address - Phone:918-647-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health