Provider Demographics
NPI:1205993854
Name:LYNCH, DARRELL (PHD)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:
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 1:6205 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5836
Mailing Address - Country:US
Mailing Address - Phone:580-536-3900
Mailing Address - Fax:580-357-8787
Practice Address - Street 1:6205 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5836
Practice Address - Country:US
Practice Address - Phone:580-536-3900
Practice Address - Fax:580-357-8787
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK244305002Medicare PIN
OK244305002Medicare UPIN