Provider Demographics
NPI:1942431937
Name:RUTLEDGE, LINDA L (LMHC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3030
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-0588
Mailing Address - Country:US
Mailing Address - Phone:360-249-2399
Mailing Address - Fax:360-262-0840
Practice Address - Street 1:501 WEST YOUNG AVE.
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-0588
Practice Address - Country:US
Practice Address - Phone:360-249-2399
Practice Address - Fax:360-262-0840
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004274101Y00000X, 101YM0800X, 101YP2500X, 102L00000X, 103K00000X, 103TB0200X, 103TP0814X
WALH00004272103TC1900X, 103TP2701X
WANU00000460133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No133N00000XDietary & Nutritional Service ProvidersNutritionist