Provider Demographics
NPI:1013034149
Name:SWANSON, LYNN N (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:N
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:NANCY
Other - Last Name:SWANSON-MANZELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11573 LOS OSOS VALLEY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405
Mailing Address - Country:US
Mailing Address - Phone:805-473-3367
Mailing Address - Fax:805-473-4769
Practice Address - Street 1:11573 LOS OSOS VALLEY RD
Practice Address - Street 2:SUITE D
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405
Practice Address - Country:US
Practice Address - Phone:805-541-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30407106H00000X
CAMFC 30704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC30407OtherPROFESSIONAL LICENSE NUMB