Provider Demographics
NPI:1467431510
Name:LUTHER-STARBIRD, LINDA SUZANNE (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUZANNE
Last Name:LUTHER-STARBIRD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:LUTHER-STARBIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1071
Mailing Address - Country:US
Mailing Address - Phone:503-224-9517
Mailing Address - Fax:844-274-0521
Practice Address - Street 1:371 SW UPPER TERRACE DR STE 3
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:503-224-9517
Practice Address - Fax:844-274-0521
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07014285Medicaid
CO035504OtherVALUE OPTIONS - CHN
CO0005107363OtherAETNA
CO42105722Medicaid
CO9129OtherBCBS
CO049696OtherHBS
COP0000864Medicare ID - Type UnspecifiedRR MEDICARE
CO42105722Medicaid