Provider Demographics
NPI:1770509564
Name:FRASER, LINDA (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 S ALAMEDA ST APT 1107
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2362
Mailing Address - Country:US
Mailing Address - Phone:361-985-2279
Mailing Address - Fax:
Practice Address - Street 1:4848 S ALAMEDA ST APT 1107
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2362
Practice Address - Country:US
Practice Address - Phone:361-985-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80954LOtherLPC - BCBS#
TX095630203Medicaid