Provider Demographics
NPI:1760686489
Name:NEUTZ, LINDA JEAN (MA CATC IV/CCS 15096)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JEAN
Last Name:NEUTZ
Suffix:
Gender:F
Credentials:MA CATC IV/CCS 15096
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 MARIGOLD WAY
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-8204
Mailing Address - Country:US
Mailing Address - Phone:805-735-9465
Mailing Address - Fax:
Practice Address - Street 1:601 E OCEAN AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6937
Practice Address - Country:US
Practice Address - Phone:805-743-1515
Practice Address - Fax:805-819-0942
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACCS #15096101YA0400X
CACATC IV 101963101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor