MEDICARE: LYNN HENTON PHD

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	103T00000X	Psychologist	3-1414	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0066LJ	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1912033226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN HENTON PHD

Provider Business Mailing Address
First Line	:	PO BOX 161102
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78716-1102
Country	:	US
Telephone Number	:	512-663-1063
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 BEE CAVE RD STE 507
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6682
Country	:	US
Telephone Number	:	512-663-1063
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	03/03/2009

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