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General NPI Number Information
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NPI Number | 1720370281
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Entity Type | Organization
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Legal Business Name | LINEBARGER WELLNESS PLLC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 6520 GLENRIDGE PARK PL SUITE ONE
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City | LOUISVILLE
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State | KY
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Zip | 40222-3453
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Country | US
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Telephone | 502-509-7357
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Fax |
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Provider Business Mailing Address
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Address Line | 517 VIRGINIA AVE
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City | LOUISVILLE
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State | KY
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Zip | 40222-6743
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Country | US
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Telephone | 502-509-7357
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED PSYCHOLOGIST
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Name | DR. LAURA A LINEBARGER
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Credential | PSYD
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Telephone | 502-509-7357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2010-102
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License Number State | KY
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