Provider Demographics
NPI:1689892762
Name:WHITE, LYNNE D (MFT)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:D
Last Name:WHITE
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 1:863 WILMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2246
Mailing Address - Country:US
Mailing Address - Phone:925-685-2409
Mailing Address - Fax:
Practice Address - Street 1:140 MAYHEW WAY STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4336
Practice Address - Country:US
Practice Address - Phone:925-685-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMCF28857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherBLUE CROSS BLUE SHIELD