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General NPI Number Information
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NPI Number | 1033388566
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Entity Type | Individual
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Provider Name | RONALD JAMES LYNCH MC, LPC, LISAC, CSAT
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Gender | Male
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 8659 W LARIAT LN SUITE 100
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City | PEORIA
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State | AZ
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Zip | 85383-4630
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Country | US
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Telephone | 623-877-8000
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Fax | 623-877-6424
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Provider Business Mailing Address
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Address Line | 8659 W LARIAT LN SUITE 100
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City | PEORIA
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State | AZ
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Zip | 85383-4630
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Country | US
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Telephone | 623-877-8000
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Fax | 623-877-6424
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC-11817
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-12197
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License Number State | AZ
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