Provider Demographics
NPI:1508098781
Name:LINTVEDT, MARTHA C (LPC,NCC,ACS)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:C
Last Name:LINTVEDT
Suffix:
Gender:F
Credentials:LPC,NCC,ACS
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:LINTVEDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1322 WINDING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6704
Mailing Address - Country:US
Mailing Address - Phone:618-531-3344
Mailing Address - Fax:
Practice Address - Street 1:8050 WATSON RD. S SUITE 335
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119
Practice Address - Country:US
Practice Address - Phone:618-531-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional