Provider Demographics
NPI:1679640700
Name:CHAZIN, LYNN ELLEN (MFT)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ELLEN
Last Name:CHAZIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E PROSPECT AVE
Mailing Address - Street 2:SUITE 218B
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3868
Mailing Address - Country:US
Mailing Address - Phone:925-217-0020
Mailing Address - Fax:
Practice Address - Street 1:145 E PROSPECT AVE
Practice Address - Street 2:SUITE 218B
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3868
Practice Address - Country:US
Practice Address - Phone:925-217-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health