Healthcare Provider Details

I. General information

NPI: 1528078946
Provider Name (Legal Business Name): AMANDA LYNCH M.A., CM-A, BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105365 S HIGHWAY 102
MCLOUD OK
74851-3051
US

IV. Provider business mailing address

628 W CENTRAL
CARNEY OK
74832-9629
US

V. Phone/Fax

Practice location:
  • Phone: 405-964-2081
  • Fax:
Mailing address:
  • Phone: 405-865-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X-HEALTH CA
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: