MEDICARE: DR. LYNN STARKER BLYTH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	888	CO

General Provider Information

NPI Number	:	1275547572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNN STARKER BLYTH PH.D.

Provider Business Mailing Address
First Line	:	1777 S HARRISON ST
Second Line	:	SUITE 840
City	:	DENVER
State	:	CO
Zip	:	80210-3925
Country	:	US
Telephone Number	:	303-744-2121
Fax Number	:	303-777-5723

Provider Business Practice Location Address
First Line	:	1777 S HARRISON ST
Second Line	:	SUITE 840
City	:	DENVER
State	:	CO
Zip	:	80210-3925
Country	:	US
Telephone Number	:	303-744-2121
Fax Number	:	303-777-5723

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/08/2007

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