MEDICARE: DARRELL LYNCH PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	573	OK

General Provider Information

NPI Number	:	1205993854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL LYNCH PHD

Provider Business Mailing Address
First Line	:	6205 W GORE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5836
Country	:	US
Telephone Number	:	580-536-3900
Fax Number	:	580-357-8787

Provider Business Practice Location Address
First Line	:	6205 W GORE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5836
Country	:	US
Telephone Number	:	580-536-3900
Fax Number	:	580-357-8787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	05/06/2009

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