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General NPI Number Information
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NPI Number | 1154647691
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Entity Type | Organization
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Legal Business Name | LYNN KILROY, PH.D., CLINICAL PSYCHOLOGIST, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 10/22/2011
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Provider Practice Location Address
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Address Line | 11340 W OLYMPIC BLVD SUITE 320
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City | LOS ANGELES
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State | CA
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Zip | 90064-1608
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Country | US
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Telephone | 310-446-8088
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Fax | 310-477-2502
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Provider Business Mailing Address
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Address Line | 11340 W OLYMPIC BLVD SUITE 320
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City | LOS ANGELES
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State | CA
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Zip | 90064-1608
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Country | US
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Telephone | 310-446-8088
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Fax | 310-477-2502
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYNN KILROY
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Credential | PH.D.
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Telephone | 310-446-8088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 15015
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License Number State | CA
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