Healthcare Provider Details

I. General information

NPI: 1588060719
Provider Name (Legal Business Name): LYNNETTE INEZ PINA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E MITCHELL DR SUITE 100 & 200
PHOENIX AZ
85012-2330
US

IV. Provider business mailing address

202 E EARLL DR SUITE 200
PHOENIX AZ
85012-2647
US

V. Phone/Fax

Practice location:
  • Phone: 602-599-5564
  • Fax: 602-248-7993
Mailing address:
  • Phone: 602-808-2800
  • Fax: 602-808-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-16745
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: