Provider Demographics
NPI:1629428420
Name:SIMPSON-REBLIN, LYNDZ (LPC)
Entity Type:Individual
Prefix:
First Name:LYNDZ
Middle Name:
Last Name:SIMPSON-REBLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16835 W ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-6870
Mailing Address - Country:US
Mailing Address - Phone:623-451-1532
Mailing Address - Fax:
Practice Address - Street 1:14040 N CAVE CREEK RD STE 108
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6117
Practice Address - Country:US
Practice Address - Phone:602-358-7073
Practice Address - Fax:888-927-0409
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-21023OtherARIZONA BOARD OF BEHAVIORAL HEALTH