Provider Demographics
NPI:1881063592
Name:DORGAN, LYNN
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:DORGAN
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 1:610 MESA DR
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2139
Mailing Address - Country:US
Mailing Address - Phone:805-340-3728
Mailing Address - Fax:
Practice Address - Street 1:921 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-5075
Practice Address - Country:US
Practice Address - Phone:805-340-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
106H00000XOtherVA CHOICE PROGRAM