Provider Demographics
NPI:1669731469
Name:GUASTELLA, LINDA BETH (LCPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:BETH
Last Name:GUASTELLA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 HEARTS CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5856
Mailing Address - Country:US
Mailing Address - Phone:617-359-1333
Mailing Address - Fax:
Practice Address - Street 1:2173 HEARTS CLUB DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5856
Practice Address - Country:US
Practice Address - Phone:617-359-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6016101YM0800X
NVCP0057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health