Provider Demographics
NPI:1952660888
Name:GARLAND, LYNN (LAC, DIPLAC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GARLAND
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:PERRY
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, DIPLAC
Mailing Address - Street 1:651 KING ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3817
Mailing Address - Country:US
Mailing Address - Phone:707-545-7525
Mailing Address - Fax:707-545-7525
Practice Address - Street 1:651 KING ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3817
Practice Address - Country:US
Practice Address - Phone:707-545-7525
Practice Address - Fax:707-545-7525
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-12
Last Update Date:2012-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9566171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA0505777OtherDRIVER'S LICENSE