Provider Demographics
NPI:1578051215
Name:HEINTZ, LINNEA MARIE (LPC, DT, CRC)
Entity Type:Individual
Prefix:
First Name:LINNEA
Middle Name:MARIE
Last Name:HEINTZ
Suffix:
Gender:F
Credentials:LPC, DT, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 SE I ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-0078
Mailing Address - Country:US
Mailing Address - Phone:479-250-4355
Mailing Address - Fax:
Practice Address - Street 1:2713 SE I ST STE 5
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-0078
Practice Address - Country:US
Practice Address - Phone:479-250-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1909119101YP2500X
AR222Q00000X, 225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty