Healthcare Provider Details

I. General information

NPI: 1659752830
Provider Name (Legal Business Name): JOSEPH LYZNICK LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2015
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 MIDNIGHT MOON LN
SIMI VALLEY CA
93065
US

IV. Provider business mailing address

292 MIDNIGHT MOON LN
SIMI VALLEY CA
93065
US

V. Phone/Fax

Practice location:
  • Phone: 805-467-7511
  • Fax:
Mailing address:
  • Phone: 805-467-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT151671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: