MEDICARE: EDDY LYNTON PHD, LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	14079	TX

General Provider Information

NPI Number	:	1710647904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDDY LYNTON PHD, LCDC

Provider Business Mailing Address
First Line	:	109 E OAK ST STE 900
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-4206
Country	:	US
Telephone Number	:	940-453-4094
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 E OAK ST STE 900
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-4206
Country	:	US
Telephone Number	:	940-453-4094
Fax Number	:

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

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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