Provider Demographics
NPI:1982268595
Name:MCDONALD, LYN GEORGE (MA)
Entity type:Individual
Prefix:MR
First Name:LYN
Middle Name:GEORGE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5219
Mailing Address - Country:US
Mailing Address - Phone:210-846-3623
Mailing Address - Fax:
Practice Address - Street 1:107 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5219
Practice Address - Country:US
Practice Address - Phone:210-846-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15276103TB0200X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral