Provider Demographics
NPI:1538774914
Name:RICHENDOLLAR, LYNN MARIE (BIS, TCADC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:RICHENDOLLAR
Suffix:
Gender:F
Credentials:BIS, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CALVERT CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42029-7617
Mailing Address - Country:US
Mailing Address - Phone:270-493-2939
Mailing Address - Fax:
Practice Address - Street 1:148 S. NELSON PARK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4200
Practice Address - Country:US
Practice Address - Phone:270-908-2681
Practice Address - Fax:270-415-5347
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263781101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)