Active NPI
Michael Anthony Lynch, PSY.D.
- Psychologist
- Fond Du Lac, WI
National Provider Identifier
1861659872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2708-57
- Practice address
- 751 County Road K
Fond Du Lac, WI 54935-7707 - Phone
- (920) 929-6702
- NPI assigned
- May 19, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3229-125 | WI | |
| Psychologist | 103T00000X | 2708-57 | WI | Primary |
Addresses
Primary practice location
751 County Road K
Fond Du Lac, WI 54935-7707
Mailing address
751 County Road K
Fond Du Lac, WI 54935-7707
Phone (920) 929-6702
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40933200 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3229-125 | WI | MD | Professional Counselor |
| 2708-57 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1861659872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "751 COUNTY ROAD K",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549357707",
"telephone_number": "920-929-6702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 COUNTY ROAD K",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549357707",
"telephone_number": "920-929-6702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYNCH",
"first_name": "MICHAEL",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-19",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "3229-125",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "2708-57",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40933200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.