Provider Demographics
NPI:1093232621
Name:LINNEAR, DARNELL
Entity Type:Individual
Prefix:MS
First Name:DARNELL
Middle Name:
Last Name:LINNEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PIERRE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-2725
Mailing Address - Country:US
Mailing Address - Phone:318-532-9214
Mailing Address - Fax:
Practice Address - Street 1:700 PIERRE AVE STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-2725
Practice Address - Country:US
Practice Address - Phone:318-532-9214
Practice Address - Fax:318-606-4519
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1912447095Medicaid