MEDICARE: LYNN BAYNE CLARK LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LPC05531	AL
2	101YM0800X	Mental Health Counselor	LPC05531	AL
3	101YP2500X	Professional Counselor	LPC05531	AL

General Provider Information

NPI Number	:	1922741354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN BAYNE CLARK LPC

Provider Business Mailing Address
First Line	:	3413 RAINBOW PKWY STE A
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3234
Country	:	US
Telephone Number	:	615-719-3201
Fax Number	:

Provider Business Practice Location Address
First Line	:	3413 RAINBOW PKWY STE A
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3234
Country	:	US
Telephone Number	:	615-719-3201
Fax Number	:

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

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	03/03/2025

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