1124269121 NPI number — MS. LYNN CAROL SHORTINO M.S., M.F.T.

Table of content: MS. LYNN CAROL SHORTINO M.S., M.F.T. (NPI 1124269121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124269121 NPI number — MS. LYNN CAROL SHORTINO M.S., M.F.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHORTINO
Provider First Name:
LYNN
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., M.F.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124269121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6520 PLATT AVE # 352
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91307-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-424-5014
Provider Business Mailing Address Fax Number:
818-884-4564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22301 MULHOLLAND HWY
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
CALABASAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91302-5140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-424-5014
Provider Business Practice Location Address Fax Number:
818-884-4564
Provider Enumeration Date:
03/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  32580 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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