Provider Demographics
NPI:1043435290
Name:HOUSMAN, LINDA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARIE
Last Name:HOUSMAN
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 1:4515 MARYLAND AVE
Mailing Address - Street 2:609
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1952
Mailing Address - Country:US
Mailing Address - Phone:314-454-1300
Mailing Address - Fax:
Practice Address - Street 1:2901 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1337
Practice Address - Country:US
Practice Address - Phone:314-531-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01883103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical