Provider Information for 1073841748
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LYNN M TIJSSEN LCPC,LADC,ACS
Sex: Female
NPI: 1073841748
Last Updated: 2010-12-23
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1073841748 | ||||||||||||
| Enumeration Date | 2009-11-18 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 804 GORHAM, ME 04038-0804 United States Phone: 207-233-4174 | Fax: | ||||||||||||
| Primary Practice Address | 50 MOODY ST SACO, ME 04072-1536 United States Phone: 207-233-4174 | Fax: | ||||||||||||
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