Provider Demographics
NPI:1629477229
Name:LOPEZ, LYNN ELLEN
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ELLEN
Last Name:LOPEZ
Suffix:
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 1:5533 VILLAGE GRN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5108
Mailing Address - Country:US
Mailing Address - Phone:818-784-7286
Mailing Address - Fax:
Practice Address - Street 1:14156 MAGNOLIA BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1181
Practice Address - Country:US
Practice Address - Phone:818-784-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT27332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist