Healthcare Provider Details

I. General information

NPI: 1467797894
Provider Name (Legal Business Name): JOE M LYNN JR. PH.D, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SW 27TH AVE STE 404
MIAMI FL
33135-4750
US

IV. Provider business mailing address

12555 BISCAYNE BLVD # 434
NORTH MIAMI FL
33181-2522
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-5255
  • Fax: 305-642-8890
Mailing address:
  • Phone: 305-928-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number283717
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 7243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: