Healthcare Provider Details

I. General information

NPI: 1851709687
Provider Name (Legal Business Name): LYNDA KATE MARTIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 FOOTHILL BLVD SUITE 360
RANCHO CUCAMONGA CA
91730-3843
US

IV. Provider business mailing address

10535 FOOTHILL BLVD SUITE 360
RANCHO CUCAMONGA CA
91730-3843
US

V. Phone/Fax

Practice location:
  • Phone: 909-499-2047
  • Fax:
Mailing address:
  • Phone: 909-499-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLMFT81068
License Number StateCA

VIII. Authorized Official

Name: MRS. LYNDA KATE MARTIN
Title or Position: LICENSED MARRIAGE AND FAMILY THERAP
Credential: LMFT
Phone: 909-499-2047