Provider Demographics
NPI:1013168137
Name:LYNN, JOANNE GLORY (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:GLORY
Last Name:LYNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 S SUNDANCE DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2410
Mailing Address - Country:US
Mailing Address - Phone:714-281-9170
Mailing Address - Fax:
Practice Address - Street 1:1085 S SUNDANCE DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2410
Practice Address - Country:US
Practice Address - Phone:714-281-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 131081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical