Provider Demographics
NPI:1245513761
Name:LYNOM, FREDA SHANTA (LMSW)
Entity type:Individual
Prefix:
First Name:FREDA
Middle Name:SHANTA
Last Name:LYNOM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:FREDA
Other - Middle Name:SHANTA
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:6674 MAY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-2426
Mailing Address - Country:US
Mailing Address - Phone:901-870-4224
Mailing Address - Fax:
Practice Address - Street 1:6674 MAY SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-2426
Practice Address - Country:US
Practice Address - Phone:901-870-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12103104100000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No104100000XBehavioral Health & Social Service ProvidersSocial Worker