=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053913368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEIDI LYNCH MENTAL HEALTH COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2020
-----------------------------------------------------
Last Update Date | 11/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 FULTON ST APT 3
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11238-6487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-269-6657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 FULTON ST APT 3
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11238-6487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | HEIDI LYNCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 929-269-6657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------