Provider Demographics
NPI:1235568445
Name:NOVAL, LINDA (PSYD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:NOVAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 NE 7TH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4542
Mailing Address - Country:US
Mailing Address - Phone:360-574-9565
Mailing Address - Fax:
Practice Address - Street 1:10000 NE 7TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4542
Practice Address - Country:US
Practice Address - Phone:360-574-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1195103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1195OtherSTATE LICENSE NUMBER
WAPY00002821OtherSTATE LICENSE NUMBER