Provider Demographics
NPI:1982154449
Name:COLEMAN, LYNN LEMCKE (EDD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:LEMCKE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 DAYTON BLVD UNIT 15781
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-4764
Mailing Address - Country:US
Mailing Address - Phone:617-203-8936
Mailing Address - Fax:
Practice Address - Street 1:3317 DAYTON BLVD UNIT 15781
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-4764
Practice Address - Country:US
Practice Address - Phone:617-203-8936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-09
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4970103TC1900X
MA11767103TC1900X
15175103TC1900X
NC6405103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11767OtherBOARD OF REGISTRATION OF PSYCHOLOGISTS
15175OtherTHE PSYPACT COMMISSION
NC6405OtherNC PSYCHOLOGY BOARD
CO4970OtherCOLORADO STATE BOARD OF PSYCHOLOGIST EXAMINERS