Provider Demographics
NPI:1598867103
Name:EFFERTZ, LYNDA P (LPC)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:P
Last Name:EFFERTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ORA
Other - Middle Name:L
Other - Last Name:EFFERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1104 BUCK AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1001
Mailing Address - Country:US
Mailing Address - Phone:817-926-7831
Mailing Address - Fax:817-926-7831
Practice Address - Street 1:6431 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-2777
Practice Address - Country:US
Practice Address - Phone:817-737-3331
Practice Address - Fax:817-737-2333
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health