Provider Demographics
NPI:1700940863
Name:LYNCH, PATRICIA SELF (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:SELF
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 COUNTY ROAD 752
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-1317
Mailing Address - Country:US
Mailing Address - Phone:936-569-7189
Mailing Address - Fax:
Practice Address - Street 1:119 NORTH ST STE I
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5200
Practice Address - Country:US
Practice Address - Phone:936-560-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124895OtherCHIP-SUPERIOR HEALTH CARE
TX10609752-01Medicaid
TX6423LCOtherBCBS