Provider Demographics
NPI:1588716146
Name:OUELLETTE, LINDA C (LPC, LISAC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E FORT LOWELL RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3985
Mailing Address - Country:US
Mailing Address - Phone:520-977-7045
Mailing Address - Fax:
Practice Address - Street 1:380 E FORT LOWELL RD
Practice Address - Street 2:SUITE 235
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3985
Practice Address - Country:US
Practice Address - Phone:520-977-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10491101YA0400X
AZLPC-11114101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional