Provider Demographics
NPI:1356383731
Name:CONYERS, LORNA LYANTHIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LORNA
Middle Name:LYANTHIE
Last Name:CONYERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LYANTHIE
Other - Middle Name:LORNA
Other - Last Name:CONYERSHARRISBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:31532 RAILROAD CANYON RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9437
Mailing Address - Country:US
Mailing Address - Phone:951-246-1055
Mailing Address - Fax:951-244-9615
Practice Address - Street 1:31532 RAILROAD CANYON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9437
Practice Address - Country:US
Practice Address - Phone:951-246-1055
Practice Address - Fax:951-244-9615
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19574103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY195740Medicaid
CAP00288631OtherRAILROAD MEDICARE
CAWCP19574BMedicare ID - Type Unspecified
CA0PL195740Medicare ID - Type Unspecified