Provider Demographics
NPI:1881833796
Name:PASS, CARYN LYNETTE (MFCTI)
Entity Type:Individual
Prefix:MS
First Name:CARYN
Middle Name:LYNETTE
Last Name:PASS
Suffix:
Gender:F
Credentials:MFCTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6494
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91909-6494
Mailing Address - Country:US
Mailing Address - Phone:619-948-1408
Mailing Address - Fax:
Practice Address - Street 1:1105 BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2767
Practice Address - Country:US
Practice Address - Phone:619-425-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53382101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health