Provider Demographics
NPI:1457935561
Name:DAVAR, LYNSEY ANNE
Entity Type:Individual
Prefix:
First Name:LYNSEY
Middle Name:ANNE
Last Name:DAVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNSEY
Other - Middle Name:ANNE
Other - Last Name:KOERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8831 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8831 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3223
Practice Address - Country:US
Practice Address - Phone:213-640-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)