Provider Demographics
NPI:1013020247
Name:HOTTENSTEIN, LINDA SUE (MED,LPC/MHSP,RPT-S)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:HOTTENSTEIN
Suffix:
Gender:F
Credentials:MED,LPC/MHSP,RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SOUTHSHORE CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9256
Mailing Address - Country:US
Mailing Address - Phone:731-664-0043
Mailing Address - Fax:731-664-0172
Practice Address - Street 1:386 CARRIAGE HOUSE DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2236
Practice Address - Country:US
Practice Address - Phone:731-664-0043
Practice Address - Fax:731-664-0172
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health