Provider Demographics
NPI:1396362901
Name:SOUTHARD, LINDA BUSSEY (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:BUSSEY
Last Name:SOUTHARD
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1736
Mailing Address - Country:US
Mailing Address - Phone:469-263-2831
Mailing Address - Fax:
Practice Address - Street 1:1913 GEORGETOWN DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1736
Practice Address - Country:US
Practice Address - Phone:469-263-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14072101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)