Provider Demographics
NPI:1922248020
Name:BULL, LYNDA GRIFFIN (MA, LAC)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:GRIFFIN
Last Name:BULL
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4568
Mailing Address - Country:US
Mailing Address - Phone:602-234-1935
Mailing Address - Fax:602-234-0022
Practice Address - Street 1:3603 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4568
Practice Address - Country:US
Practice Address - Phone:602-234-1935
Practice Address - Fax:602-234-0022
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-12709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional