MEDICARE: BRANDY LYNETTE LYNCH

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	106S00000X	Behavior Technician		MI

General Provider Information

NPI Number	:	1346756079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY LYNETTE LYNCH

Provider Business Mailing Address
First Line	:	1360 PORTER ST # 1STFLOOR
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2890
Country	:	US
Telephone Number	:	313-689-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 PORTER ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2890
Country	:	US
Telephone Number	:	313-689-5188
Fax Number	:

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

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	12/18/2017

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Directions to “ BRANDY LYNETTE LYNCH ” Practice Location

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