Healthcare Provider Details

I. General information

NPI: 1114130630
Provider Name (Legal Business Name): LINDA C. KERTH PH.D., M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S 1ST ST CONNECTIONS, INC. ATTN LINDA KERTH
GALLUP NM
87301-6211
US

IV. Provider business mailing address

303 S 1ST ST CONNECTIONS, INC. ATTN LINDA KERTH
GALLUP NM
87301-6211
US

V. Phone/Fax

Practice location:
  • Phone: 505-862-7080
  • Fax: 505-722-9870
Mailing address:
  • Phone: 505-722-0641
  • Fax: 505-722-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0101531
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: