Provider Demographics
NPI:1760027445
Name:LYNES, SAMANTHA RENEE (NCC, LCMHC, MHC, LPC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:RENEE
Last Name:LYNES
Suffix:
Gender:F
Credentials:NCC, LCMHC, MHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 LAKE TAPPS DR SE APT 104
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8774
Mailing Address - Country:US
Mailing Address - Phone:253-508-7857
Mailing Address - Fax:
Practice Address - Street 1:11510 19TH AVENUE CT S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1434
Practice Address - Country:US
Practice Address - Phone:253-508-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8126101YM0800X
NC15260101YM0800X
WALH61261913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1234738OtherNBCC
NCLCMHC15260OtherNORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS
ORC8126OtherOREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS
WALH61261913OtherWASHINGTON STATE DEPARTMENT OF HEALTH