Provider Demographics
NPI:1316349061
Name:CODY, LINZI BRUCH (LPC, PHD)
Entity type:Individual
Prefix:DR
First Name:LINZI
Middle Name:BRUCH
Last Name:CODY
Suffix:
Gender:F
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:ANN
Other - Last Name:BRUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3381 S DEBBIE ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-8555
Mailing Address - Country:US
Mailing Address - Phone:480-326-7896
Mailing Address - Fax:
Practice Address - Street 1:408 N KENDRICK ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1582
Practice Address - Country:US
Practice Address - Phone:928-774-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15258101YP2500X
AZ4780103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional