Provider Demographics
NPI:1629633771
Name:MARTINDALE, LYNETTA LAVON (LMFT)
Entity Type:Individual
Prefix:
First Name:LYNETTA
Middle Name:LAVON
Last Name:MARTINDALE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4787 E ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6087
Mailing Address - Country:US
Mailing Address - Phone:435-238-0291
Mailing Address - Fax:
Practice Address - Street 1:4787 E ADDISON AVE
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-6087
Practice Address - Country:US
Practice Address - Phone:435-238-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8701348-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist