MEDICARE: KEITH NATHANIEL 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1861760332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH NATHANIEL LYNCH

Provider Business Mailing Address
First Line	:	704 MILL ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-1321
Country	:	US
Telephone Number	:	775-954-1400
Fax Number	:	775-954-1406

Provider Business Practice Location Address
First Line	:	704 MILL ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-1321
Country	:	US
Telephone Number	:	775-954-1400
Fax Number	:	775-954-1406

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

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	02/17/2014

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Directions to “ KEITH NATHANIEL LYNCH ” Practice Location

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