Provider Demographics
NPI:1649402645
Name:SPENCER, LYNNETTE DIANE (LYNNETTE SPENCER MFT)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:DIANE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LYNNETTE SPENCER MFT
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LYNNETTE SPENCER MFT
Mailing Address - Street 1:4120 CAMERON PARK DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7212
Mailing Address - Country:US
Mailing Address - Phone:530-318-1858
Mailing Address - Fax:
Practice Address - Street 1:1300 OLIVER RD STE 193
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3431
Practice Address - Country:US
Practice Address - Phone:707-514-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist