Provider Demographics
NPI:1982847570
Name:CUNDIFF, LYNNE B (LPAT)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:B
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1110
Mailing Address - Country:US
Mailing Address - Phone:502-396-8456
Mailing Address - Fax:
Practice Address - Street 1:206 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1110
Practice Address - Country:US
Practice Address - Phone:502-396-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health