Provider Demographics
NPI:1245370170
Name:LYNN, DALE (BS)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:LYNN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 OLD MURFREESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3444
Mailing Address - Country:US
Mailing Address - Phone:931-728-1038
Mailing Address - Fax:
Practice Address - Street 1:115 DYER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3915
Practice Address - Country:US
Practice Address - Phone:931-560-4220
Practice Address - Fax:931-560-4221
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health