Provider Demographics
NPI:1568853463
Name:DANIELS, LYNNDAL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:LYNNDAL
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94083-0371
Mailing Address - Country:US
Mailing Address - Phone:415-712-2328
Mailing Address - Fax:415-614-4206
Practice Address - Street 1:534 AVALON DR
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5558
Practice Address - Country:US
Practice Address - Phone:415-712-2328
Practice Address - Fax:415-614-4206
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist