Provider Demographics
NPI:1801989157
Name:BUDD, LINDA (PHD, LP, LMFT, RPT-S)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:BUDD
Suffix:
Gender:F
Credentials:PHD, LP, LMFT, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 COMO AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1718
Mailing Address - Country:US
Mailing Address - Phone:651-644-8235
Mailing Address - Fax:651-765-1834
Practice Address - Street 1:2301 COMO AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1718
Practice Address - Country:US
Practice Address - Phone:651-644-8235
Practice Address - Fax:651-765-1834
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2628103TC2200X
MN0244106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1142687OtherSTATE TAX IDENTIFIER