Provider Demographics
NPI:1821679622
Name:PETERSON, LARYNDA LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:LARYNDA
Middle Name:LYNN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LARYNDA
Other - Middle Name:LYNN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:3355 N WHITE AVE # 253
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-6112
Mailing Address - Country:US
Mailing Address - Phone:626-253-8899
Mailing Address - Fax:
Practice Address - Street 1:2120 FOOTHILL BLVD STE 213
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2950
Practice Address - Country:US
Practice Address - Phone:909-575-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist