1861680167 NPI number — MS. LINDA LANDELE JETER LMFT

Table of content: MS. LINDA LANDELE JETER LMFT (NPI 1861680167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861680167 NPI number — MS. LINDA LANDELE JETER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JETER
Provider First Name:
LINDA
Provider Middle Name:
LANDELE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JETER
Provider Other First Name:
LINDA
Provider Other Middle Name:
LANDELE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861680167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10717 CAMINO RUIZ STE 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92126-2364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-695-2211
Provider Business Mailing Address Fax Number:
858-695-3521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4975 WILLIAMS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-7408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-837-3439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2007

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: 106H00000X , with the licence number:  105090 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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