Provider Demographics
NPI:1699895888
Name:AUSTIN, LINDA JEAN (MFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:AUSTIN
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 1:4303 CORNWELL RD
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2330
Mailing Address - Country:US
Mailing Address - Phone:831-477-1956
Mailing Address - Fax:831-477-1956
Practice Address - Street 1:4303 CORNWELL RD
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2330
Practice Address - Country:US
Practice Address - Phone:831-477-1956
Practice Address - Fax:831-477-1956
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist