Provider Demographics
NPI:1447522891
Name:FREDERICK, LINDA (MED, LPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 IH 10 N STE 110
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4815
Mailing Address - Country:US
Mailing Address - Phone:409-201-1233
Mailing Address - Fax:
Practice Address - Street 1:985 IH 10 N STE 110
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-4815
Practice Address - Country:US
Practice Address - Phone:409-201-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional