Active NPI
Lyn Ashley Gildar
- Clinical Psychologist
- Glendale, AZ
National Provider Identifier
1053646364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4587
- Practice address
- 4319 W Bell Rd Ste 4319
Glendale, AZ 85308-3530 - Phone
- (602) 888-0448
- Fax
- (844) 578-8867
- NPI assigned
- Oct 5, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | CA | ||
| Clinical Psychologist | 103TC0700X | 4587 | AZ | Primary |
Addresses
Primary practice location
4319 W Bell Rd Ste 4319
Glendale, AZ 85308-3530
Mailing address
4319 W Bell Rd Ste 4319
Glendale, AZ 85308-3530
Phone (602) 888-0448
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 017438 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4587 | AZ | MD | Surgery of the Hand (Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692230400000",
"number": "1053646364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4319 W BELL RD STE 4319",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853083530",
"telephone_number": "602-888-0448",
"fax_number": "844-578-8867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4319 W BELL RD STE 4319",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853083530",
"telephone_number": "602-888-0448",
"fax_number": "844-578-8867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILDAR",
"first_name": "LYN ASHLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-05",
"last_updated": "2023-08-17",
"certification_date": "2023-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "4587",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "017438",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.