Basic Information
| Provider Information | |||||||||
| NPI: | 1861042400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 HONEY CREEK AVE SE | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493019790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166486651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 360 E BELTLINE AVE NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495061214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168053660 | ||||||||
| FaxNumber: | 6168053631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2019 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801105612 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.