Provider Demographics
NPI:1104949197
Name:LAFFERTY, LINDA JEAN (MFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96062-0113
Mailing Address - Country:US
Mailing Address - Phone:530-222-9234
Mailing Address - Fax:530-222-2854
Practice Address - Street 1:448 REDCLIFF DR
Practice Address - Street 2:STE. 215
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0161
Practice Address - Country:US
Practice Address - Phone:530-222-9237
Practice Address - Fax:530-222-2854
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist