Provider Demographics
NPI:1528078946
Name:LYNCH, AMANDA (MA, CM-A, BHRS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MA, CM-A, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 W CENTRAL
Mailing Address - Street 2:
Mailing Address - City:CARNEY
Mailing Address - State:OK
Mailing Address - Zip Code:74832-9629
Mailing Address - Country:US
Mailing Address - Phone:405-865-2059
Mailing Address - Fax:
Practice Address - Street 1:105365 S HIGHWAY 102
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-3051
Practice Address - Country:US
Practice Address - Phone:405-964-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X-HEALTH CA390200000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program