Provider Demographics
NPI:1356359699
Name:KELLY, LYNNE G (LMFT)
Entity type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:G
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:LYNNE
Other - Middle Name:G
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1230 SUN VALLEY LOOP
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8492
Mailing Address - Country:US
Mailing Address - Phone:916-253-3993
Mailing Address - Fax:
Practice Address - Street 1:898 5TH ST STE E
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1774
Practice Address - Country:US
Practice Address - Phone:916-759-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist