Provider Demographics
NPI:1487811303
Name:LYNN, MARK B (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:B
Last Name:LYNN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 ST HWY 71 W STE 350-367
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6517
Mailing Address - Country:US
Mailing Address - Phone:512-743-2059
Mailing Address - Fax:
Practice Address - Street 1:1015 BEECAVE WOODS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6762
Practice Address - Country:US
Practice Address - Phone:512-743-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX403591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical