Provider Demographics
NPI:1548515745
Name:CHASTAIN, LINDA KAREN (LPC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:KAREN
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:CHASTAIN
Other - Last Name:KRIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:94235 MOORE ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444
Mailing Address - Country:US
Mailing Address - Phone:541-247-4082
Mailing Address - Fax:541-247-5058
Practice Address - Street 1:94235 MOORE ST
Practice Address - Street 2:SUITE 412
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444
Practice Address - Country:US
Practice Address - Phone:541-247-4082
Practice Address - Fax:541-247-5058
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional