Basic Information
| Provider Information | |||||||||
| NPI: | 1881833796 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASS | ||||||||
| FirstName: | CARYN | ||||||||
| MiddleName: | LYNETTE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MFCTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6494 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919096494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199481408 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1105 BROADWAY STE 207 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919112767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194255609 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2009 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 53382 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 53382 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.