Provider Demographics
NPI:1851842470
Name:BENNETT, LINDA PIKE (LMHC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:PIKE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 CENTRAL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3160
Mailing Address - Country:US
Mailing Address - Phone:505-412-7756
Mailing Address - Fax:
Practice Address - Street 1:1475 CENTRAL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3160
Practice Address - Country:US
Practice Address - Phone:505-412-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0184281101YM0800X
NM0186941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health