Healthcare Provider Details

I. General information

NPI: 1467315259
Provider Name (Legal Business Name): MIA P LYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 VICTOR ST
BELLINGHAM WA
98225-2240
US

IV. Provider business mailing address

2727 MICHIGAN ST
BELLINGHAM WA
98226-4036
US

V. Phone/Fax

Practice location:
  • Phone: 360-393-8725
  • Fax:
Mailing address:
  • Phone: 360-393-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61636021
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: