Provider Demographics
NPI:1669573754
Name:LINDELL, BEVERLY J (LMFT)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:LINDELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-4525
Mailing Address - Country:US
Mailing Address - Phone:715-373-2233
Mailing Address - Fax:715-373-5530
Practice Address - Street 1:101 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-4525
Practice Address - Country:US
Practice Address - Phone:715-373-2233
Practice Address - Fax:715-373-5530
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI597-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43578400Medicaid