MEDICARE: LYNCIA WRIGHT-WHITE

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	103K00000X	Behavior Analyst	W623564676726	MI

General Provider Information

NPI Number	:	1689097750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNCIA WRIGHT-WHITE

Provider Business Mailing Address
First Line	:	2148 RASPBERRY CT SE APT M
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-5973
Country	:	US
Telephone Number	:	616-325-5906
Fax Number	:

Provider Business Practice Location Address
First Line	:	2148 RASPBERRY CT SE APT M
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-5973
Country	:	US
Telephone Number	:	616-325-5906
Fax Number	:

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

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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Directions to “ LYNCIA WRIGHT-WHITE ” Practice Location

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