Provider Demographics
NPI:1134145543
Name:ROUNTREE, LYN ANN (MA, MA, MFT, PPS)
Entity Type:Individual
Prefix:MRS
First Name:LYN
Middle Name:ANN
Last Name:ROUNTREE
Suffix:
Gender:F
Credentials:MA, MA, MFT, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28974 WHITMORE RD
Mailing Address - Street 2:
Mailing Address - City:WHITMORE
Mailing Address - State:CA
Mailing Address - Zip Code:96096-9562
Mailing Address - Country:US
Mailing Address - Phone:530-472-1307
Mailing Address - Fax:
Practice Address - Street 1:28974 WHITMORE RD
Practice Address - Street 2:
Practice Address - City:WHITMORE
Practice Address - State:CA
Practice Address - Zip Code:96096-9562
Practice Address - Country:US
Practice Address - Phone:530-472-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist