Healthcare Provider Details

I. General information

NPI: 1033275235
Provider Name (Legal Business Name): LINDA KAY LAZURE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 OAK GROVE RD SUITE 11
CONCORD CA
94518-3289
US

IV. Provider business mailing address

2551 SAN RAMON VALLEY BLVD STE 210
SAN RAMON CA
94583-1662
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5061
  • Fax:
Mailing address:
  • Phone: 925-743-9388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number28546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: