Provider Demographics
NPI:1700037736
Name:LYNCH, SANDRA MOENSSENS (LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MOENSSENS
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:BIRKELBACH
Other - Last Name:MOENSSENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 917
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34760
Mailing Address - Country:US
Mailing Address - Phone:321-230-0740
Mailing Address - Fax:
Practice Address - Street 1:17307 PAGONLA DR. SUITE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:321-230-0740
Practice Address - Fax:352-577-8972
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2360106H00000X
FLMH9675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1497062491OtherNPI