Provider Demographics
NPI:1871743484
Name:MAUTZ, LINDA KAY (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KAY
Last Name:MAUTZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:MARKLE
Mailing Address - State:IN
Mailing Address - Zip Code:46770-0263
Mailing Address - Country:US
Mailing Address - Phone:260-388-9403
Mailing Address - Fax:
Practice Address - Street 1:810 N CLARK ST
Practice Address - Street 2:
Practice Address - City:MARKLE
Practice Address - State:IN
Practice Address - Zip Code:46770-9787
Practice Address - Country:US
Practice Address - Phone:260-388-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002011A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health