Healthcare Provider Details

I. General information

NPI: 1639627698
Provider Name (Legal Business Name): JODY LYMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 BRODER BLVD
DUBLIN CA
94568-3309
US

IV. Provider business mailing address

5325 BRODER BLVD
DUBLIN CA
94568-3309
US

V. Phone/Fax

Practice location:
  • Phone: 510-542-0753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11176
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108824
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: