Provider Demographics
NPI:1992470561
Name:LIT LYNNY'S INNER THERAPY
Entity type:Organization
Organization Name:LIT LYNNY'S INNER THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CHENGAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:SSW
Authorized Official - Phone:385-337-4391
Mailing Address - Street 1:PO BOX 16621
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-0621
Mailing Address - Country:US
Mailing Address - Phone:385-337-4391
Mailing Address - Fax:
Practice Address - Street 1:314 W BROADWAY STE 222
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2038
Practice Address - Country:US
Practice Address - Phone:385-337-4391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-15
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty