Provider Demographics
NPI:1295079994
Name:DURHAM, LYNEE MINOR
Entity type:Individual
Prefix:MRS
First Name:LYNEE
Middle Name:MINOR
Last Name:DURHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNEE
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:5118 FOUNTAINHEAD DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5813
Mailing Address - Country:US
Mailing Address - Phone:615-557-3375
Mailing Address - Fax:615-661-7720
Practice Address - Street 1:1711 19TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3701
Practice Address - Country:US
Practice Address - Phone:615-557-3375
Practice Address - Fax:615-383-4473
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional