Provider Demographics
NPI:1083360739
Name:LINDAHL, MARSHA A (LPA/LSSP MS)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:A
Last Name:LINDAHL
Suffix:
Gender:F
Credentials:LPA/LSSP MS
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:MENEFEE
Other - Last Name:LINDAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPA/LSSP MS
Mailing Address - Street 1:483 CROOKED CRK
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2794
Mailing Address - Country:US
Mailing Address - Phone:512-659-5586
Mailing Address - Fax:
Practice Address - Street 1:483 CROOKED CRK
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2794
Practice Address - Country:US
Practice Address - Phone:512-659-5586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6520103TS0200X
TX5723103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5723OtherTEXAS STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS
TX6520OtherTEXAS STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS