Provider Demographics
NPI:1881716744
Name:COMLEY, LYNN (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:COMLEY
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VISTA LAGO DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4050
Mailing Address - Country:US
Mailing Address - Phone:805-583-0821
Mailing Address - Fax:805-583-2743
Practice Address - Street 1:15 VISTA LAGO DR
Practice Address - Street 2:SUITE L
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4050
Practice Address - Country:US
Practice Address - Phone:805-583-0821
Practice Address - Fax:805-583-2743
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 30361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist