Provider Demographics
NPI:1194870683
Name:OUELLETTE, LINDA M (PHD, LMHC, LMFT,)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:PHD, LMHC, LMFT,
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:M
Other - Last Name:VANDERBLEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LMHC, LMFT
Mailing Address - Street 1:724 VENTURA DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5755
Mailing Address - Country:US
Mailing Address - Phone:321-289-8928
Mailing Address - Fax:
Practice Address - Street 1:1250 W EAU GALLIE BLVD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5385
Practice Address - Country:US
Practice Address - Phone:321-289-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5334101YM0800X
FLMT 2098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health