Provider Demographics
NPI:1124276050
Name:MCLEOD, LYNN (LYNN MCLEOD, MFT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:LYNN MCLEOD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 TAMAL VISTA BLVD
Mailing Address - Street 2:SUITE 162
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1132
Mailing Address - Country:US
Mailing Address - Phone:415-388-2544
Mailing Address - Fax:
Practice Address - Street 1:240 TAMAL VISTA BLVD
Practice Address - Street 2:SUITE 162
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1132
Practice Address - Country:US
Practice Address - Phone:415-388-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30747106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist