Healthcare Provider Details

I. General information

NPI: 1376594820
Provider Name (Legal Business Name): MICHELLE SHANNON LYNCH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9035 WADSWORTH PKWY STE 2600
WESTMINSTER CO
80021-8627
US

IV. Provider business mailing address

9035 WADSWORTH PKWY STE 2600
WESTMINSTER CO
80021-8627
US

V. Phone/Fax

Practice location:
  • Phone: 720-845-2988
  • Fax: 888-639-9341
Mailing address:
  • Phone: 248-808-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301012771
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: