Provider Demographics
NPI:1154647691
Name:LYNN KILROY, PH.D., CLINICAL PSYCHOLOGIST, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LYNN KILROY, PH.D., CLINICAL PSYCHOLOGIST, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILROY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-446-8088
Mailing Address - Street 1:11340 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1608
Mailing Address - Country:US
Mailing Address - Phone:310-446-8088
Mailing Address - Fax:310-477-2502
Practice Address - Street 1:11340 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1608
Practice Address - Country:US
Practice Address - Phone:310-446-8088
Practice Address - Fax:310-477-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty