Provider Demographics
NPI:1003900077
Name:NIST, LINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:NIST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 MONROE AVE. SUITE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-4147
Mailing Address - Country:US
Mailing Address - Phone:330-602-5339
Mailing Address - Fax:330-602-4388
Practice Address - Street 1:1260 MONROE AVE SUITE 1A
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-4147
Practice Address - Country:US
Practice Address - Phone:330-602-5339
Practice Address - Fax:330-602-4388
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3411-S101YP2500X
OH6293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional