Provider Demographics
NPI:1134160955
Name:LYNCH, TIMOTHY D (PHD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-504-4357
Mailing Address - Fax:615-230-8987
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 413
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-504-4357
Practice Address - Fax:615-230-8987
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1476137103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3052526OtherBCBS
TN3682737Medicaid
TN3052526OtherBCBS