Provider Demographics
NPI:1467503540
Name:POLO, LINDA (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:POLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W HICKORY ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4156
Mailing Address - Country:US
Mailing Address - Phone:940-565-1818
Mailing Address - Fax:940-387-8378
Practice Address - Street 1:207 W HICKORY ST
Practice Address - Street 2:SUITE 306
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4156
Practice Address - Country:US
Practice Address - Phone:940-565-1818
Practice Address - Fax:940-387-8378
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2491103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist