Provider Demographics
NPI:1265130348
Name:LINEMAN, CHARLA ANN (LMFT ASSOCIATE)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:ANN
Last Name:LINEMAN
Suffix:
Gender:F
Credentials:LMFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13814 MAYE PL APT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-7744
Mailing Address - Country:US
Mailing Address - Phone:512-964-8856
Mailing Address - Fax:
Practice Address - Street 1:13805 ANN PL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-7702
Practice Address - Country:US
Practice Address - Phone:512-964-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204875106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist