Provider Demographics
NPI:1356471809
Name:HARBERT, LYNDA A (MFT)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:A
Last Name:HARBERT
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 1:6354 PAINTER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4632
Mailing Address - Country:US
Mailing Address - Phone:562-696-9918
Mailing Address - Fax:626-573-9550
Practice Address - Street 1:6354 PAINTER AVE FL 2
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4632
Practice Address - Country:US
Practice Address - Phone:562-696-9918
Practice Address - Fax:626-573-9550
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ936672OtherBLUE SHIELD OF CALIFORNIA
CA67129OtherMANAGED HEALTH NETWORK