Provider Demographics
NPI:1073888277
Name:WOODLEY, LONNIE O (MA, MS, LMFT, LEP, P)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:O
Last Name:WOODLEY
Suffix:
Gender:M
Credentials:MA, MS, LMFT, LEP, P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1204
Mailing Address - Country:US
Mailing Address - Phone:818-242-8403
Mailing Address - Fax:818-242-3187
Practice Address - Street 1:920 E BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1204
Practice Address - Country:US
Practice Address - Phone:818-242-8403
Practice Address - Fax:818-242-3187
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA#95-2633765OtherMEDI-CAL