Provider Demographics
NPI:1609112275
Name:VAN TOL, LINDA M (LMFT, CSAC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:VAN TOL
Suffix:
Gender:F
Credentials:LMFT, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 VAN HISE AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53726-3823
Mailing Address - Country:US
Mailing Address - Phone:608-238-0010
Mailing Address - Fax:
Practice Address - Street 1:2310 VAN HISE AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53726-3823
Practice Address - Country:US
Practice Address - Phone:608-238-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10894-132101YA0400X
WI313-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)