Provider Demographics
NPI:1770175739
Name:LYNCH, ALEXIS MACKENZIE (RMHI)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MACKENZIE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RMHI
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:MACKENZIE
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13801 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2412
Mailing Address - Country:US
Mailing Address - Phone:813-252-1527
Mailing Address - Fax:
Practice Address - Street 1:13801 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2412
Practice Address - Country:US
Practice Address - Phone:813-252-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1770175739OtherIPN