Provider Demographics
NPI:1407983034
Name:MULLESTEIN, LINDA (MS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:MULLESTEIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 WOODS ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05036
Mailing Address - Country:US
Mailing Address - Phone:802-276-3078
Mailing Address - Fax:
Practice Address - Street 1:7 MAIN STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MONTPELLER
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-229-4406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000302101YA0400X
VT0680000128101YM0800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist