Healthcare Provider Details

I. General information

NPI: 1023258001
Provider Name (Legal Business Name): PATTY JEAN LINVILLE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATTY JEAN LINVILLE LCPC, LPC, LAC

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FORT CARSON CO
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIR
FORT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-2775
  • Fax: 719-526-9927
Mailing address:
  • Phone: 719-526-2775
  • Fax: 719-526-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0000354
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0011619
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008654
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: