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General NPI Number Information
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NPI Number | 1255874459
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Entity Type | Organization
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Legal Business Name | LYRA CLINICAL ASSOCIATES P.C.
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 287 LORTON AVE
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City | BURLINGAME
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State | CA
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Zip | 94010-4203
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Country | US
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Telephone | 800-505-5972
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Fax |
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Provider Business Mailing Address
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Address Line | 287 LORTON AVE
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City | BURLINGAME
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State | CA
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Zip | 94010-4203
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Country | US
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Telephone | 800-505-5972
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT KOCHER
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Credential | MD
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Telephone | 800-505-5972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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