=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922627850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN MINNEA NEWMAN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2020
-----------------------------------------------------
Last Update Date | 04/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6280 OASIS RD
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96003-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-524-2559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 277
-----------------------------------------------------
City | SHASTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96087-0277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-524-2559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT42117
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------