=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861680167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA LANDELE JETER LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 N BRAND BLVD STE 700
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-844-2095
-----------------------------------------------------
Fax | 309-661-6800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10717 CAMINO RUIZ STE 207
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92126-2364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-695-2211
-----------------------------------------------------
Fax | 858-695-3521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 105090
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------