Doctor Name: | DR. LORNA LYANTHIE CONYERS |
NPI Number: | 1356383731 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | PSY 19574 |
Business Practice Address: | 31532 Railroad Canyon Rd Suite 105 Canyon Lake, CA - 925879437 |
Business Phone Number: | 9512461055 |
Business Fax Number: | 9512449615 |
Mailing Address: | 31532 Railroad Canyon Rd, Suite 105 CANYON LAKE |
State: | CA |
Postal Code: | 925879437 |
Phone Number: | 9512461055 |
Fax Number: | 9512449615 |
NPI Enumeration Date: | 06/12/2006 |
NPI Last Update Date: | 04/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY 19574 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |