Provider Demographics
NPI:1952478067
Name:MATAR, LYNNETTE (MA LPC NCC LLP)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:MATAR
Suffix:
Gender:F
Credentials:MA LPC NCC LLP
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:
Other - Last Name:LUBINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPC NCC LLP
Mailing Address - Street 1:5340 HOLIDAY TER STE 13
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2181
Mailing Address - Country:US
Mailing Address - Phone:269-372-4140
Mailing Address - Fax:269-372-0390
Practice Address - Street 1:5340 HOLIDAY TER STE 13
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2181
Practice Address - Country:US
Practice Address - Phone:269-372-4140
Practice Address - Fax:269-372-0390
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012444103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist