Provider Demographics
NPI:1043574791
Name:COLLETT, LINDA (MFT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:COLLETT
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 1:2524 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8667
Mailing Address - Country:US
Mailing Address - Phone:707-322-8198
Mailing Address - Fax:
Practice Address - Street 1:4527 MONTGOMERY DR
Practice Address - Street 2:SUITE F
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5363
Practice Address - Country:US
Practice Address - Phone:707-322-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45886106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist