Healthcare Provider Details

I. General information

NPI: 1891014312
Provider Name (Legal Business Name): SHIRLEY J LANYI PHD A PSYCHOLOGICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRING ST STE 204
LA MESA CA
91942-0263
US

IV. Provider business mailing address

4700 SPRING ST STE 204
LA MESA CA
91942-0263
US

V. Phone/Fax

Practice location:
  • Phone: 619-908-6445
  • Fax: 619-589-6840
Mailing address:
  • Phone: 619-908-6445
  • Fax: 619-589-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY12078
License Number StateCA

VIII. Authorized Official

Name: STEPHANIE E SHELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 760-295-2950