Provider Demographics
NPI:1245301555
Name:GANTT, LYNDA MAXINE (PHD, MFT)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:MAXINE
Last Name:GANTT
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E COOK ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5141
Mailing Address - Country:US
Mailing Address - Phone:805-922-1093
Mailing Address - Fax:805-922-6777
Practice Address - Street 1:301 E COOK ST
Practice Address - Street 2:SUITE K
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5141
Practice Address - Country:US
Practice Address - Phone:805-922-1093
Practice Address - Fax:805-922-6777
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27809106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist