Provider Demographics
NPI:1750951422
Name:TERESA JEAN LYNCH
Entity type:Organization
Organization Name:TERESA JEAN LYNCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:989-615-5989
Mailing Address - Street 1:3909 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3758
Mailing Address - Country:US
Mailing Address - Phone:989-615-5989
Mailing Address - Fax:989-607-2119
Practice Address - Street 1:1717 E SUGNET RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-3827
Practice Address - Country:US
Practice Address - Phone:989-615-5989
Practice Address - Fax:989-607-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty