Provider Demographics
NPI:1720370281
Name:LINEBARGER WELLNESS PLLC
Entity Type:Organization
Organization Name:LINEBARGER WELLNESS PLLC
Other - Org Name:LINEBARGER WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINEBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:502-509-7357
Mailing Address - Street 1:517 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6743
Mailing Address - Country:US
Mailing Address - Phone:502-509-7357
Mailing Address - Fax:
Practice Address - Street 1:6520 GLENRIDGE PARK PL
Practice Address - Street 2:SUITE ONE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3453
Practice Address - Country:US
Practice Address - Phone:502-509-7357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2010-102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty