Provider Demographics
NPI:1164120168
Name:RODDY, ALLISON LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:LYNN
Last Name:RODDY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:LYNN
Other - Last Name:RODDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:21062 BROOKHURST ST STE 208
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7400
Mailing Address - Country:US
Mailing Address - Phone:330-719-7158
Mailing Address - Fax:
Practice Address - Street 1:21062 BROOKHURST ST STE 208
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7400
Practice Address - Country:US
Practice Address - Phone:330-719-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94026467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical