Healthcare Provider Details

I. General information

NPI: 1255378006
Provider Name (Legal Business Name): JULIANNA M LYELL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5175 E PACIFIC COAST HWY SUITE 304
LONG BEACH CA
90804-3317
US

IV. Provider business mailing address

5175 E PACIFIC COAST HWY SUITE 304
LONG BEACH CA
90804-3317
US

V. Phone/Fax

Practice location:
  • Phone: 562-221-4141
  • Fax:
Mailing address:
  • Phone: 562-221-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: