Provider Demographics
NPI:1023258001
Name:LINVILLE, PATTY JEAN (MA)
Entity type:Individual
Prefix:MS
First Name:PATTY
Middle Name:JEAN
Last Name:LINVILLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:PATTY
Other - Middle Name:JEAN
Other - Last Name:LINVILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC, LPC, LAC
Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-526-2775
Mailing Address - Fax:719-526-9927
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-2775
Practice Address - Fax:719-526-9927
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000354101YA0400X
COLPC.0011619101YM0800X
IL180.008654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health