MEDICARE: MS. SANDRA LYNCH-BASS L.M.F.T.

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	106H00000X	Marriage & Family Therapist	MT 1858	FL

General Provider Information

NPI Number	:	1841494234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA LYNCH-BASS L.M.F.T.

Provider Business Mailing Address
First Line	:	907 GINGER TREE PL
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-7778
Country	:	US
Telephone Number	:	386-547-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1182 PELICAN BAY DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1381
Country	:	US
Telephone Number	:	386-547-2876
Fax Number	:

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	04/15/2015

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