Provider Demographics
NPI:1568791846
Name:MOODY, LYNETTE FAYE I
Entity Type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:FAYE
Last Name:MOODY
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 ATLANTA AVE STE D3
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7418
Mailing Address - Country:US
Mailing Address - Phone:951-955-8000
Mailing Address - Fax:951-955-8010
Practice Address - Street 1:3892 STOTTS ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3826
Practice Address - Country:US
Practice Address - Phone:951-955-8000
Practice Address - Fax:951-955-8010
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor