Healthcare Provider Details

I. General information

NPI: 1558277103
Provider Name (Legal Business Name): NICHOLE RAYLEEN LYNCH LMSW-21761
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W GUADALUPE RD STE 301
GILBERT AZ
85233-3333
US

IV. Provider business mailing address

109 E CATCLAW ST
GILBERT AZ
85296-2809
US

V. Phone/Fax

Practice location:
  • Phone: 480-870-8080
  • Fax:
Mailing address:
  • Phone: 480-287-2964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-21761
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: