Provider Demographics
NPI:1467811539
Name:RAFOOL BIDWELL, LYNNE (LMFT, LPCC)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:
Last Name:RAFOOL BIDWELL
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:MS
Other - First Name:LYNNE
Other - Middle Name:
Other - Last Name:BIDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, LPCC
Mailing Address - Street 1:12160 MONTANA AVE
Mailing Address - Street 2:#10
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5271
Mailing Address - Country:US
Mailing Address - Phone:310-741-2256
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:SUITE 810
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2601
Practice Address - Country:US
Practice Address - Phone:323-451-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist