Provider Demographics
NPI:1689880585
Name:KLUG, LINDA D (MFT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:KLUG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 E LOS ANGELES AVE STE 237
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-5829
Mailing Address - Country:US
Mailing Address - Phone:805-526-2190
Mailing Address - Fax:805-583-2816
Practice Address - Street 1:1720 E LOS ANGELES AVE STE 237
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-5829
Practice Address - Country:US
Practice Address - Phone:805-526-2190
Practice Address - Fax:805-583-2816
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist