Provider Demographics
NPI:1114130630
Name:KERTH, LINDA C (PHD, MA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:KERTH
Suffix:
Gender:F
Credentials:PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S 1ST ST
Mailing Address - Street 2:CONNECTIONS, INC. ATTN LINDA KERTH
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6211
Mailing Address - Country:US
Mailing Address - Phone:505-722-0641
Mailing Address - Fax:505-722-9870
Practice Address - Street 1:303 S 1ST ST
Practice Address - Street 2:CONNECTIONS, INC. ATTN LINDA KERTH
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6211
Practice Address - Country:US
Practice Address - Phone:505-862-7080
Practice Address - Fax:505-722-9870
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0101531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health