Healthcare Provider Details

I. General information

NPI: 1477029148
Provider Name (Legal Business Name): SALLY JEANNE LYNCH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 HOTEL CIR S STE 250
SAN DIEGO CA
92108-3428
US

IV. Provider business mailing address

1545 HOTEL CIR S STE 250
SAN DIEGO CA
92108-3428
US

V. Phone/Fax

Practice location:
  • Phone: 619-800-4313
  • Fax:
Mailing address:
  • Phone: 619-800-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number759
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number124617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: