Provider Demographics
NPI:1588953525
Name:LINN, MARY FRANCIS (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCIS
Last Name:LINN
Suffix:
Gender:F
Credentials:LPC-S
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 688
Mailing Address - Street 2:
Mailing Address - City:VILLAGE MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:77663-0688
Mailing Address - Country:US
Mailing Address - Phone:409-980-6176
Mailing Address - Fax:
Practice Address - Street 1:802 WEST BLACKGUM
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:TX
Practice Address - Zip Code:77663-0688
Practice Address - Country:US
Practice Address - Phone:409-980-6176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17079Medicaid