Provider Demographics
NPI:1447353461
Name:GOODREAU, LYNELLE LORI (MA MFT)
Entity type:Individual
Prefix:MS
First Name:LYNELLE
Middle Name:LORI
Last Name:GOODREAU
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 VENTURA BLVD
Mailing Address - Street 2:#324
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-995-3547
Mailing Address - Fax:310-820-4432
Practice Address - Street 1:15300 VENTURA BLVD
Practice Address - Street 2:#324
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-995-3547
Practice Address - Fax:310-820-4432
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist