Provider Demographics
NPI:1134402381
Name:LYNCH, IRIS BONITA (CADC-11)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:BONITA
Last Name:LYNCH
Suffix:
Gender:F
Credentials:CADC-11
Other - Prefix:MS
Other - First Name:IRIS
Other - Middle Name:BONITA
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC
Mailing Address - Street 1:911 N NORTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1640
Mailing Address - Country:US
Mailing Address - Phone:818-217-7034
Mailing Address - Fax:
Practice Address - Street 1:18646 OXNARD ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1411
Practice Address - Country:US
Practice Address - Phone:818-996-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARAS71011101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor