Healthcare Provider Details

I. General information

NPI: 1386047686
Provider Name (Legal Business Name): LYNDA YI MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W BASTANCHURY RD SUITE 1A
FULLERTON CA
92835-2522
US

IV. Provider business mailing address

111 W BASTANCHURY RD SUITE 1A
FULLERTON CA
92835-2522
US

V. Phone/Fax

Practice location:
  • Phone: 714-773-4111
  • Fax: 714-773-4222
Mailing address:
  • Phone: 714-773-4111
  • Fax: 714-773-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT82568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: