Provider Demographics
NPI:1386654325
Name:LINEBARGER, HAL A (PSYD, PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:A
Last Name:LINEBARGER
Suffix:
Gender:M
Credentials:PSYD, PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1184
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-1184
Mailing Address - Country:US
Mailing Address - Phone:530-219-8080
Mailing Address - Fax:
Practice Address - Street 1:2055 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1210
Practice Address - Country:US
Practice Address - Phone:530-219-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21579103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA335770OtherMANAGED HEALTH NETWORK
CA330255266-29OtherPACIFICARE BEHAVIORAL HEA