Provider Demographics
NPI:1205588860
Name:MAGNUSON, LYNNA LEA
Entity type:Individual
Prefix:
First Name:LYNNA
Middle Name:LEA
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 YGNACIO VALLEY RD APT 70
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3252
Mailing Address - Country:US
Mailing Address - Phone:925-408-2119
Mailing Address - Fax:
Practice Address - Street 1:1919 YGNACIO VALLEY RD APT 70
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3252
Practice Address - Country:US
Practice Address - Phone:925-408-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor