Provider Demographics
NPI:1891014312
Name:SHIRLEY J LANYI PHD A PSYCHOLOGICAL CORP
Entity Type:Organization
Organization Name:SHIRLEY J LANYI PHD A PSYCHOLOGICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-295-2950
Mailing Address - Street 1:4700 SPRING ST
Mailing Address - Street 2:STE 204
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0263
Mailing Address - Country:US
Mailing Address - Phone:619-908-6445
Mailing Address - Fax:619-589-6840
Practice Address - Street 1:4700 SPRING ST
Practice Address - Street 2:STE 204
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0263
Practice Address - Country:US
Practice Address - Phone:619-908-6445
Practice Address - Fax:619-589-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12078103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12078Medicare PIN