Provider Demographics
NPI:1215627112
Name:LYNCH GUERINGER, DAVID MICHAEL (AMFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:LYNCH GUERINGER
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:GUERINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:2591 FAIR OAKS AVE # 103
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-5074
Mailing Address - Country:US
Mailing Address - Phone:310-923-3283
Mailing Address - Fax:
Practice Address - Street 1:225 W BROADWAY STE 155
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1332
Practice Address - Country:US
Practice Address - Phone:818-333-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist