Provider Demographics
NPI:1497860803
Name:CHRISTY, LINDA (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:298 WESTRIDGE DRIVE
Mailing Address - City:YOUNG
Mailing Address - State:AZ
Mailing Address - Zip Code:85554-0271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:298 WESTRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:YOUNG
Practice Address - State:AZ
Practice Address - Zip Code:85554-0271
Practice Address - Country:US
Practice Address - Phone:928-462-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 11590101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool