Provider Demographics
NPI:1083726483
Name:LINDBERG, AUTUMN A (LMFT)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:A
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:A
Other - Last Name:MANNWIELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:245 N. PLAZA DR.
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-302-4125
Mailing Address - Fax:
Practice Address - Street 1:245 N. PLAZA DR.
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-302-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 49129101YM0800X
CAMFC46951106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0027211Medicare ID - Type Unspecified