Provider Demographics
NPI:1588925135
Name:KAWABE, LYNN
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:KAWABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W 149TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2729
Mailing Address - Country:US
Mailing Address - Phone:626-470-9834
Mailing Address - Fax:866-541-3233
Practice Address - Street 1:37 AUBURN AVE STE 1
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1846
Practice Address - Country:US
Practice Address - Phone:626-470-9834
Practice Address - Fax:866-541-3233
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105244106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist