MEDICARE: FREDA SHANTA LYNOM LMSW

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	104100000X	Social Worker	12103	TN
2	374J00000X	Doula

General Provider Information

NPI Number	:	1245513761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDA SHANTA LYNOM LMSW

Provider Business Mailing Address
First Line	:	6674 MAY SPRINGS DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38141-2426
Country	:	US
Telephone Number	:	901-870-4224
Fax Number	:

Provider Business Practice Location Address
First Line	:	6674 MAY SPRINGS DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38141-2426
Country	:	US
Telephone Number	:	901-870-4224
Fax Number	:

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

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	12/07/2024

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