Provider Demographics
NPI:1336447580
Name:WELCH, LYNN C (MFT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:WELCH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 ALVARADO RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1543
Mailing Address - Country:US
Mailing Address - Phone:415-515-4523
Mailing Address - Fax:510-705-1088
Practice Address - Street 1:5463 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1502
Practice Address - Country:US
Practice Address - Phone:510-356-4311
Practice Address - Fax:510-705-1088
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist