Healthcare Provider Details

I. General information

NPI: 1740300813
Provider Name (Legal Business Name): LINDA HALLMARK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S MAIN ST
LEBANON OR
97355-3109
US

IV. Provider business mailing address

250 NW COUNTRY CLUB LN
ALBANY OR
97321-8701
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-5932
  • Fax:
Mailing address:
  • Phone: 541-791-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0078
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: