Provider Demographics
NPI:1932457017
Name:MINTON, LYNN MICHELLE (LCSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MICHELLE
Last Name:MINTON
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-1085
Mailing Address - Country:US
Mailing Address - Phone:812-583-4003
Mailing Address - Fax:
Practice Address - Street 1:1149 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3721
Practice Address - Country:US
Practice Address - Phone:812-583-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004392A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical