Healthcare Provider Details

I. General information

NPI: 1104653252
Provider Name (Legal Business Name): SEAN LYNN, INDIVIDUAL AND FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AVIATION BLVD STE 102
REDONDO BEACH CA
90278-4063
US

IV. Provider business mailing address

1200 AVIATION BLVD STE 102
REDONDO BEACH CA
90278-4063
US

V. Phone/Fax

Practice location:
  • Phone: 714-235-8858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SEAN LYNN
Title or Position: CEO
Credential: LMFT
Phone: 714-235-8858