Provider Demographics
NPI:1376606301
Name:WILLOUGHBY, LINDA TEAL (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:TEAL
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 AIRPORT FWY
Mailing Address - Street 2:SUITE 334
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6850
Mailing Address - Country:US
Mailing Address - Phone:817-571-7400
Mailing Address - Fax:817-571-7406
Practice Address - Street 1:1600 AIRPORT FWY
Practice Address - Street 2:SUITE 334
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6850
Practice Address - Country:US
Practice Address - Phone:817-571-7400
Practice Address - Fax:817-571-7406
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 12328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health