Provider Demographics
NPI:1710089446
Name:ELDREDGE, LINDA G (EDD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:ELDREDGE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:G
Other - Last Name:ELDREDGE-THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:4601 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:BLDG 4 SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-467-1376
Mailing Address - Fax:512-467-8658
Practice Address - Street 1:4601 SPICEWOOD SPRINGS RD
Practice Address - Street 2:BLDG 4 SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-467-1376
Practice Address - Fax:512-467-8658
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OOG95YOtherBCBS PROVIDER NUMBER