Provider Demographics
NPI:1801523998
Name:LYNCH, PAUL RUSSELL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:RUSSELL
Last Name:LYNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S E ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4709
Mailing Address - Country:US
Mailing Address - Phone:707-573-6960
Mailing Address - Fax:707-573-6968
Practice Address - Street 1:201 S E ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4709
Practice Address - Country:US
Practice Address - Phone:707-573-6860
Practice Address - Fax:707-573-6968
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health