Provider Demographics
NPI:1093721441
Name:SHESTOCK, LINDA A (LMFT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:SHESTOCK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3371 E CIRCULO SAN SORRENTO RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1758
Mailing Address - Country:US
Mailing Address - Phone:951-640-1225
Mailing Address - Fax:760-325-8391
Practice Address - Street 1:1490 N CLAREMONT BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3519
Practice Address - Country:US
Practice Address - Phone:909-998-0050
Practice Address - Fax:760-325-8391
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40396106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist