Provider Demographics
NPI:1497078109
Name:ALLEN, LYNNE M
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LYNNE
Other - Middle Name:M
Other - Last Name:RUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSAC
Mailing Address - Street 1:1601 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5035
Mailing Address - Country:US
Mailing Address - Phone:562-590-9010
Mailing Address - Fax:
Practice Address - Street 1:1601 E 10TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5035
Practice Address - Country:US
Practice Address - Phone:562-590-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198600681101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor