Provider Demographics
NPI:1811991870
Name:REED, LYNNE (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2356
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-2356
Mailing Address - Country:US
Mailing Address - Phone:707-331-9938
Mailing Address - Fax:
Practice Address - Street 1:15801 CAMINO DEL ARROYO
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446-9311
Practice Address - Country:US
Practice Address - Phone:707-331-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3274103G00000X, 103TC0700X, 103TC2200X
CAPSY7290103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ42681Medicare UPIN
CA0PL729000Medicare ID - Type UnspecifiedMEDICARE PART B