Provider Demographics
NPI:1528208907
Name:LINEBARGER, KEINA (LMFT 94844)
Entity Type:Individual
Prefix:
First Name:KEINA
Middle Name:
Last Name:LINEBARGER
Suffix:
Gender:F
Credentials:LMFT 94844
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 166
Mailing Address - Street 2:
Mailing Address - City:TAHOE VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:96148-0166
Mailing Address - Country:US
Mailing Address - Phone:619-540-4111
Mailing Address - Fax:530-494-0204
Practice Address - Street 1:7005 N LAKE BLVD # 166
Practice Address - Street 2:
Practice Address - City:TAHOE VISTA
Practice Address - State:CA
Practice Address - Zip Code:96148-9800
Practice Address - Country:US
Practice Address - Phone:619-540-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT94844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist