Provider Demographics
NPI:1740410919
Name:LYNCH, MECHIBELLE MABANTA (MD)
Entity type:Individual
Prefix:DR
First Name:MECHIBELLE
Middle Name:MABANTA
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIR STE 450
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4835
Mailing Address - Country:US
Mailing Address - Phone:502-890-4007
Mailing Address - Fax:502-742-4609
Practice Address - Street 1:4010 DUPONT CIR STE 450
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4835
Practice Address - Country:US
Practice Address - Phone:502-890-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP24842084P0800X
NV148332084P0800X
KY469252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry