Healthcare Provider Details

I. General information

NPI: 1659749596
Provider Name (Legal Business Name): MARY MARGARET LYNCH CRC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 JAMESTOWN AVE
INDEPENDENCE IA
50644-9709
US

IV. Provider business mailing address

2349 JAMESTOWN AVE
INDEPENDENCE IA
50644-9709
US

V. Phone/Fax

Practice location:
  • Phone: 319-499-5366
  • Fax: 319-499-5366
Mailing address:
  • Phone: 319-499-5366
  • Fax: 319-499-5366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00113598
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001344
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: