Healthcare Provider Details

I. General information

NPI: 1952478067
Provider Name (Legal Business Name): LYNNETTE MATAR MA LPC NCC LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNNETTE LUBINSKI MA LPC NCC LLP

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 HOLIDAY TER STE 13
KALAMAZOO MI
49009-2181
US

IV. Provider business mailing address

5340 HOLIDAY TER STE 13
KALAMAZOO MI
49009-2181
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-4140
  • Fax: 269-372-0390
Mailing address:
  • Phone: 269-372-4140
  • Fax: 269-372-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301012444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: