Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY002974 | GA |
NPI | 1073841862 |
---|---|
Provider Name | Michelle K Lyn |
First Address | Decatur, GA 30037-2515 |
Second Address | Decatur, GA 30030-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2009 |
Last Update Date | 17/01/2011 |