Provider Demographics
NPI:1134374952
Name:LYNCH, JULIE ANNE (MED)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 S AVONDALE BLVD
Mailing Address - Street 2:1252 S. AVONDALE BLVD.
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-8900
Mailing Address - Country:US
Mailing Address - Phone:623-478-5700
Mailing Address - Fax:623-478-5720
Practice Address - Street 1:1252 S AVONDALE BLVD
Practice Address - Street 2:1252 S. AVONDALE BLVD.
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-8900
Practice Address - Country:US
Practice Address - Phone:623-478-5700
Practice Address - Fax:623-478-5720
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3888807101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool