Provider Demographics
NPI:1952434524
Name:AURICH, LYNN WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:WAYNE
Last Name:AURICH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIDGEWAY DR
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3404
Mailing Address - Country:US
Mailing Address - Phone:337-593-0404
Mailing Address - Fax:
Practice Address - Street 1:125 RIDGEWAY DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3404
Practice Address - Country:US
Practice Address - Phone:337-593-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA266103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAR15454Medicare UPIN
LA56287Medicare ID - Type Unspecified