MEDICARE: DR. LYNETTE WALKER LIVELY COOKSON PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	35422	CA

General Provider Information

NPI Number	:	1326563529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNETTE WALKER LIVELY COOKSON PSYD

Provider Business Mailing Address
First Line	:	11230 SORRENTO VALLEY RD STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1300
Country	:	US
Telephone Number	:	858-215-6634
Fax Number	:

Provider Business Practice Location Address
First Line	:	11230 SORRENTO VALLEY RD STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1300
Country	:	US
Telephone Number	:	858-648-5367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	06/01/2026

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