Provider Demographics
NPI:1326599093
Name:WYMAN, LIBERTY SHEA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LIBERTY
Middle Name:SHEA
Last Name:WYMAN
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 1:28766 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-4601
Mailing Address - Country:US
Mailing Address - Phone:760-596-2000
Mailing Address - Fax:
Practice Address - Street 1:400 S 2ND AVE STE 105
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2805
Practice Address - Country:US
Practice Address - Phone:760-596-2000
Practice Address - Fax:855-255-3331
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist