Healthcare Provider Details

I. General information

NPI: 1982154449
Provider Name (Legal Business Name): LYNN LEMCKE COLEMAN EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2016
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 DAYTON BLVD UNIT 15781
CHATTANOOGA TN
37415-4764
US

IV. Provider business mailing address

3317 DAYTON BLVD UNIT 15781
CHATTANOOGA TN
37415-4764
US

V. Phone/Fax

Practice location:
  • Phone: 617-203-8936
  • Fax:
Mailing address:
  • Phone: 617-203-8936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4970
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number11767
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number15175
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: