Provider Demographics
NPI:1700881356
Name:PIERSON, LYNN HAROLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:HAROLD
Last Name:PIERSON
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 1:2734 CHANCELLOR DR
Mailing Address - Street 2:STE 211
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3487
Mailing Address - Country:US
Mailing Address - Phone:513-535-8025
Mailing Address - Fax:
Practice Address - Street 1:2734 CHANCELLOR DR
Practice Address - Street 2:STE 211
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3487
Practice Address - Country:US
Practice Address - Phone:513-535-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-19
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1568103TC0700X, 106H00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP19931Medicare ID - Type Unspecified