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6010 Highway 9 Ste 1 Felton CA 95018-9535 | |
| (972) 876-9131 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 6010 Highway 9 Ste 1, Felton, California |
| Authorized Official Name and Position | Lynelle Marie Lynn (PRESIDENT/PSYCHOLOGIST) |
| Authorized Official Contact | 8317047257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6010 Highway 9 Ste 1 Felton CA 95018-9535 Ph: (972) 876-9131 | 6010 Highway 9 Ste 1 Felton CA 95018-9535 Ph: (972) 876-9131 |
| NPI Number | 1225485568 |
|---|---|
| Provider Enumeration Date | 05/17/2016 |
| Last Update Date | 04/27/2021 |
| Certification Date | 04/27/2021 |
| Medicare PECOS PAC ID | 3072805431 |
|---|---|
| Medicare Enrollment ID | O20210519000596 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225485568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 36032 (Texas) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Lynelle Marie Lynn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215288329 PECOS PAC ID: 9032369228 Enrollment ID: I20210119000985 |
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