Provider Demographics
NPI:1134482961
Name:BURBANK, LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BURBANK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:A
Other - Last Name:BURBANK-LENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:38 W LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1805
Mailing Address - Country:US
Mailing Address - Phone:310-717-8636
Mailing Address - Fax:
Practice Address - Street 1:711 E WALNUT ST
Practice Address - Street 2:SUITE 408
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1676
Practice Address - Country:US
Practice Address - Phone:310-717-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist