Provider Demographics
NPI:1972815405
Name:PERREAULT, LINDA (LMFT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:GEIPEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:5536 LINDA ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7630
Mailing Address - Country:US
Mailing Address - Phone:619-980-8805
Mailing Address - Fax:
Practice Address - Street 1:4670 NEBO DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5230
Practice Address - Country:US
Practice Address - Phone:619-980-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist