Healthcare Provider Details

I. General information

NPI: 1629399159
Provider Name (Legal Business Name): LINDA CATHCART M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12170 E CORNVILLE RD
CORNVILLE AZ
86325-5260
US

IV. Provider business mailing address

12170 E CORNVILLE RD
CORNVILLE AZ
86325-5260
US

V. Phone/Fax

Practice location:
  • Phone: 928-301-4596
  • Fax:
Mailing address:
  • Phone: 928-301-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1963676
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: