Provider Demographics
NPI:1295910438
Name:HUERTA, LYNDA LENNOX (MFT)
Entity type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:LENNOX
Last Name:HUERTA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:LYNDA
Other - Middle Name:J
Other - Last Name:LENNOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2755 JEFFERSON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1714
Mailing Address - Country:US
Mailing Address - Phone:760-720-2002
Mailing Address - Fax:
Practice Address - Street 1:2755 JEFFERSON ST STE 104
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1714
Practice Address - Country:US
Practice Address - Phone:760-720-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54220MFT24517OtherBLUE SHEILD OF CA