Healthcare Provider Details

I. General information

NPI: 1093911216
Provider Name (Legal Business Name): LARRY LYNCH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 N 23RD AVE STE 120
PHOENIX AZ
85021-4149
US

IV. Provider business mailing address

6262 S SHERIDAN RD
TULSA OK
74133-4055
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-8800
  • Fax: 602-265-8151
Mailing address:
  • Phone: 918-492-8200
  • Fax: 918-493-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2422
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: