Provider Demographics
NPI:1215288329
Name:LYNN, LYNELLE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LYNELLE
Middle Name:MARIE
Last Name:LYNN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LYNELLE
Other - Middle Name:MARIE
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:6010 HIGHWAY 9 STE 1
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9535
Mailing Address - Country:US
Mailing Address - Phone:972-876-9131
Mailing Address - Fax:
Practice Address - Street 1:6010 HIGHWAY 9 STE 1
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9535
Practice Address - Country:US
Practice Address - Phone:972-876-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32165103TC0700X
TX36032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical