Provider Demographics
NPI:1740795095
Name:LYNCH, CORNEL REESE JR
Entity type:Individual
Prefix:
First Name:CORNEL
Middle Name:REESE
Last Name:LYNCH
Suffix:JR
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 1:33464 SCHOENHERR RD STE 180
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-6392
Mailing Address - Country:US
Mailing Address - Phone:586-999-5971
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:15600 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3502
Practice Address - Country:US
Practice Address - Phone:586-999-5971
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2025-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511194001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical