Provider Demographics
NPI:1982251799
Name:LYNCH, SHEILA ANNE
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANNE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-4741
Mailing Address - Country:US
Mailing Address - Phone:866-926-6552
Mailing Address - Fax:580-303-4238
Practice Address - Street 1:213 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4741
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:580-303-4238
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK305R00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health