Provider Demographics
NPI:1962670083
Name:AYON, LYDIA (MA, MFTI)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:AYON
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3926
Mailing Address - Country:US
Mailing Address - Phone:530-406-7221
Mailing Address - Fax:530-406-7222
Practice Address - Street 1:409 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3926
Practice Address - Country:US
Practice Address - Phone:530-406-7221
Practice Address - Fax:530-406-7222
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 44938106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist