Healthcare Provider Details

I. General information

NPI: 1760686489
Provider Name (Legal Business Name): LINDA JEAN NEUTZ MA CATC IV/CCS 15096
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E OCEAN AVE SUITE 20
LOMPOC CA
93436-6937
US

IV. Provider business mailing address

1324 MARIGOLD WAY
LOMPOC CA
93436-8204
US

V. Phone/Fax

Practice location:
  • Phone: 805-743-1515
  • Fax: 805-819-0942
Mailing address:
  • Phone: 805-735-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCS #15096
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCATC IV 101963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: