Provider Demographics
NPI:1083880116
Name:SMITH, LINDA ANNE (MARRIAGE & FAMILY TH)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MARRIAGE & FAMILY TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81711 HWY 111
Mailing Address - Street 2:STE 101
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-347-2398
Mailing Address - Fax:760-347-6468
Practice Address - Street 1:81711 HWY 111
Practice Address - Street 2:STE 101
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-347-2398
Practice Address - Fax:760-347-6468
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMP45575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist