Basic Information
| Provider Information | |||||||||
| NPI: | 1659992394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CLINICAN ACSW 101153 | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99 | ||||||||
| Address2: | |||||||||
| City: | MARIPOSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953380099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096172662 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5362 LEMEE LN | ||||||||
| Address2: | |||||||||
| City: | MARIPOSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953389556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099662000 | ||||||||
| FaxNumber: | 2097420996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2020 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW101153 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | ASW101153 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.