Provider Demographics
NPI:1164590451
Name:WEIDNER-ALVAREZ, LORI LYN (MFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYN
Last Name:WEIDNER-ALVAREZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 ANDREA CT
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5614
Mailing Address - Country:US
Mailing Address - Phone:760-499-7448
Mailing Address - Fax:760-499-7498
Practice Address - Street 1:1615 N DOWNS ST
Practice Address - Street 2:SUITE B
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2429
Practice Address - Country:US
Practice Address - Phone:760-499-7448
Practice Address - Fax:760-499-7498
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC25256OtherLICENSE