Basic Information
| Provider Information | |||||||||
| NPI: | 1386277242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYNN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | R. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 SOUTHERN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425013223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066794782 | ||||||||
| FaxNumber: | 6066785296 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 HERRIFORD CURVE ROAD | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 426292520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703432551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2020 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 261889 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.