1811290075 NPI number — LYNNETTA LAVONNE DEVEREAUX IMF

Table of content: LYNNETTA LAVONNE DEVEREAUX IMF (NPI 1811290075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811290075 NPI number — LYNNETTA LAVONNE DEVEREAUX IMF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVEREAUX
Provider First Name:
LYNNETTA
Provider Middle Name:
LAVONNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IMF
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEVEREAUX
Provider Other First Name:
LYNNETTA
Provider Other Middle Name:
LAVONNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1811290075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
979 WOODLAND PKWY STE 101-81
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92069-2226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-829-5917
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 S MELROSE DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92081-6696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-940-4803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2010

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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