Provider Demographics
NPI:1992971188
Name:BLOCK, LINDA DIANNE (MFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANNE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MFT
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 91
Mailing Address - Street 2:
Mailing Address - City:KERNVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93238-0091
Mailing Address - Country:US
Mailing Address - Phone:310-871-8795
Mailing Address - Fax:760-379-1793
Practice Address - Street 1:4300 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240
Practice Address - Country:US
Practice Address - Phone:310-871-8795
Practice Address - Fax:760-379-1793
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist