Provider Demographics
NPI:1245960582
Name:LYNCH, KELLIE THRIFT (RBT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:THRIFT
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:MARLENE
Other - Last Name:THRIFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 W ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0714
Mailing Address - Country:US
Mailing Address - Phone:912-385-2927
Mailing Address - Fax:912-385-2928
Practice Address - Street 1:1316 W ORANGE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0714
Practice Address - Country:US
Practice Address - Phone:912-385-2927
Practice Address - Fax:912-385-2928
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-22-219619106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician