Provider Demographics
NPI:1558584912
Name:GOURLEY, LINDA ANN (PHD, PA-C)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:PHD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1884
Mailing Address - Country:US
Mailing Address - Phone:415-436-0330
Mailing Address - Fax:415-753-1601
Practice Address - Street 1:3527 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1884
Practice Address - Country:US
Practice Address - Phone:415-436-0330
Practice Address - Fax:415-753-1601
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13334103G00000X, 103TB0200X, 103TC0700X, 103TH0004X
CAPA11286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant