Provider Demographics
NPI:1467439711
Name:MAGRUDER, LINDA D (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:MAGRUDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUTH MAIN
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5202
Mailing Address - Country:US
Mailing Address - Phone:573-686-5090
Mailing Address - Fax:573-785-4104
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5843
Practice Address - Country:US
Practice Address - Phone:573-686-5090
Practice Address - Fax:573-785-4104
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000168791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495097016Medicaid
MO430956146OtherTRICARE
MO685831OtherHEALTHLINK
MO175128OtherBLUE CROSS BLUE SHIELD
MO2104426OtherCIGNA
MO430956146OtherMH NET AND UNITY EAP