Provider Demographics
NPI:1194374967
Name:LINDA MY THERAPIST
Entity Type:Organization
Organization Name:LINDA MY THERAPIST
Other - Org Name:RISING SUN COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-989-0021
Mailing Address - Street 1:13659 E 104TH AVE, STE 500
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-9409
Mailing Address - Country:US
Mailing Address - Phone:720-339-9830
Mailing Address - Fax:303-484-6256
Practice Address - Street 1:13575 E 104TH AVE STE 300-400
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-8400
Practice Address - Country:US
Practice Address - Phone:720-339-9830
Practice Address - Fax:303-484-6256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000175730Medicaid