Provider Demographics
NPI:1306955810
Name:VINSON, LYNN JUBELT (LLP, LMSW)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:JUBELT
Last Name:VINSON
Suffix:
Gender:F
Credentials:LLP, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5324
Mailing Address - Country:US
Mailing Address - Phone:810-985-9118
Mailing Address - Fax:810-985-9135
Practice Address - Street 1:821 7TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5324
Practice Address - Country:US
Practice Address - Phone:810-985-9118
Practice Address - Fax:810-985-9135
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006054103TC0700X
MI68010636331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical