Provider Demographics
NPI:1215724919
Name:LYN, TINA (MS, MHC-LP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:LYN
Suffix:
Gender:
Credentials:MS, MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ADIRONDACK ST
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-6007
Mailing Address - Country:US
Mailing Address - Phone:518-637-3500
Mailing Address - Fax:
Practice Address - Street 1:1441 BROADWAY FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1879
Practice Address - Country:US
Practice Address - Phone:646-389-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP134727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health