Provider Demographics
NPI:1215583737
Name:MATIN, LYRA ANGELICA VELAYO (LMFT)
Entity Type:Individual
Prefix:
First Name:LYRA ANGELICA
Middle Name:VELAYO
Last Name:MATIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28553 SPARROW WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3295
Mailing Address - Country:US
Mailing Address - Phone:213-807-3709
Mailing Address - Fax:
Practice Address - Street 1:28553 SPARROW WAY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3295
Practice Address - Country:US
Practice Address - Phone:213-807-3709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT126563106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty