Healthcare Provider Details

I. General information

NPI: 1639236722
Provider Name (Legal Business Name): LINDA DUFF GUMM LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 N. INTERSTATE 35
WAXAHACHIE TX
75165
US

IV. Provider business mailing address

319 RAY AVE
DESOTO TX
75115-3222
US

V. Phone/Fax

Practice location:
  • Phone: 972-617-6222
  • Fax: 972-617-0655
Mailing address:
  • Phone: 972-228-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17945
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: