Provider Demographics
NPI:1639422553
Name:GREEN-BASKETT, LINDA J (LMHC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:GREEN-BASKETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 S 4820 W
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-6422
Mailing Address - Country:US
Mailing Address - Phone:801-966-4251
Mailing Address - Fax:801-966-4289
Practice Address - Street 1:5242 S 4820 W
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-6422
Practice Address - Country:US
Practice Address - Phone:801-966-4251
Practice Address - Fax:801-966-4289
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006181101YM0800X
UT8627168-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health