1467550764 NPI number — MS. LINDA L WINTER LPCC LADAC

Table of content: MS. LINDA L WINTER LPCC LADAC (NPI 1467550764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467550764 NPI number — MS. LINDA L WINTER LPCC LADAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINTER
Provider First Name:
LINDA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC LADAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SNODGRASS
Provider Other First Name:
LINDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467550764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
837 SOLAR RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-344-2048
Provider Business Mailing Address Fax Number:
505-766-9402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
837 SOLAR RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-344-2048
Provider Business Practice Location Address Fax Number:
505-766-9402
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CADAC3638 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: LPCC0591 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP2500X , with the licence number: LPCC0591 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B8945 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM102186 . This is a "VAL OPS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".