Provider Demographics
NPI:1184747099
Name:MCNULTY, LIN K (JD, LCSW)
Entity type:Individual
Prefix:DR
First Name:LIN
Middle Name:K
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:JD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2149
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959
Mailing Address - Country:US
Mailing Address - Phone:530-274-7560
Mailing Address - Fax:
Practice Address - Street 1:655 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7535
Practice Address - Country:US
Practice Address - Phone:530-274-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health