Provider Demographics
NPI:1285972489
Name:BERG, LYNN B (PSYD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:B
Last Name:BERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HORSETRAIL CT
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-2654
Mailing Address - Country:US
Mailing Address - Phone:214-673-7795
Mailing Address - Fax:
Practice Address - Street 1:401 HORSETRAIL CT
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-2654
Practice Address - Country:US
Practice Address - Phone:214-673-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical