Healthcare Provider Details

I. General information

NPI: 1821412602
Provider Name (Legal Business Name): LAURA LININGER, LCSW COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W KIRKWOOD AVE FOUNTAIN SQUARE, SUITE 218
BLOOMINGTON IN
47404-6129
US

IV. Provider business mailing address

101 W KIRKWOOD AVE FOUNTAIN SQUARE, SUITE 218
BLOOMINGTON IN
47404-6129
US

V. Phone/Fax

Practice location:
  • Phone: 812-327-6842
  • Fax: 812-676-9351
Mailing address:
  • Phone: 812-327-6842
  • Fax: 812-676-9351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34003425A
License Number StateIN

VIII. Authorized Official

Name: MS. LAURA DIANE LININGER
Title or Position: SOLE PROPRIETOR/ THERAPIST
Credential: LCSW
Phone: 812-327-6842