Provider Demographics
NPI:1881833390
Name:BENNARDO, LINDA ELAINE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELAINE
Last Name:BENNARDO
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 1:257 JUSTIN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-5189
Mailing Address - Country:US
Mailing Address - Phone:928-821-4505
Mailing Address - Fax:
Practice Address - Street 1:257 JUSTIN DR
Practice Address - Street 2:SUITE A
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-5189
Practice Address - Country:US
Practice Address - Phone:928-821-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-08
Last Update Date:2009-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC12144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health