Provider Demographics
NPI:1841328242
Name:LYN, KENNETH K (MA, LMFT, MBA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:K
Last Name:LYN
Suffix:
Gender:M
Credentials:MA, LMFT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18917 PLUMAS CIR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4133
Mailing Address - Country:US
Mailing Address - Phone:626-617-4889
Mailing Address - Fax:
Practice Address - Street 1:1910 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-1220
Practice Address - Country:US
Practice Address - Phone:213-342-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist