Provider Demographics
NPI:1689793952
Name:DETLING, LYNDA H (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:H
Last Name:DETLING
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 1:1601 DOVE ST
Mailing Address - Street 2:STE 230
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-263-1633
Mailing Address - Fax:949-833-3467
Practice Address - Street 1:1601 DOVE ST
Practice Address - Street 2:STE 230
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-263-1633
Practice Address - Fax:949-833-3467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC13217106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist