Provider Demographics
NPI:1285917344
Name:LYNCH, MILDRED JEANETTE (MED)
Entity type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:JEANETTE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 NW 30TH TER
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4154
Mailing Address - Country:US
Mailing Address - Phone:405-354-6010
Mailing Address - Fax:
Practice Address - Street 1:300 S RANCHWOOD BLVD
Practice Address - Street 2:SUITE 15-16
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2741
Practice Address - Country:US
Practice Address - Phone:405-354-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor