Provider Demographics
NPI:1548375595
Name:WEITZEL, LINDA ANN (LPC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:WEITZEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:WEITZEL
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:634 MAIN ST
Mailing Address - Street 2:STE. 7
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2777
Mailing Address - Country:US
Mailing Address - Phone:970-242-6954
Mailing Address - Fax:970-255-0585
Practice Address - Street 1:634 MAIN ST
Practice Address - Street 2:STE. 7
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2777
Practice Address - Country:US
Practice Address - Phone:970-242-6954
Practice Address - Fax:970-255-0585
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO080672Medicaid