Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | 2064 | SC |
NPI | 1114937307 |
---|---|
Provider Name | Kevin Bryan Lynch |
First Address | Spartanburg, SC 29303-2712 |
Second Address | Spartanburg, SC 29303-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |