Provider Demographics
NPI:1154652931
Name:CLOSE, LINDA CLAIRE (MED, LMHC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CLAIRE
Last Name:CLOSE
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20757 NW 9TH CT
Mailing Address - Street 2:APT. 107
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6811
Mailing Address - Country:US
Mailing Address - Phone:954-579-3036
Mailing Address - Fax:
Practice Address - Street 1:6521 ORANGE DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3340
Practice Address - Country:US
Practice Address - Phone:954-579-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health