Healthcare Provider Details

I. General information

NPI: 1841762846
Provider Name (Legal Business Name): LYNZIE TINGLE CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 S WILLOW ST STE 266
MANCHESTER NH
03103-5751
US

IV. Provider business mailing address

2312 DURWOOD RD
LITTLE ROCK AR
72207-3431
US

V. Phone/Fax

Practice location:
  • Phone: 877-315-8080
  • Fax:
Mailing address:
  • Phone: 501-313-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-46960
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: