Provider Demographics
NPI:1558430967
Name:MARIE, LYNN G (MA CLINICAL PSYCH)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:G
Last Name:MARIE
Suffix:
Gender:F
Credentials:MA CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4319
Mailing Address - Country:US
Mailing Address - Phone:805-928-1707
Mailing Address - Fax:805-922-4797
Practice Address - Street 1:150 B SO. 6TH ST.
Practice Address - Street 2:SUITE B
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433
Practice Address - Country:US
Practice Address - Phone:805-547-5738
Practice Address - Fax:805-481-6316
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist