Provider Demographics
NPI:1588041172
Name:FRIES, LINDA (MFT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FRIES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 STONERIDGE MALL RD STE 15
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2822
Mailing Address - Country:US
Mailing Address - Phone:925-461-6411
Mailing Address - Fax:925-227-1145
Practice Address - Street 1:5700 STONERIDGE MALL RD STE 315
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2850
Practice Address - Country:US
Practice Address - Phone:925-461-6411
Practice Address - Fax:925-227-1145
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-03
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT30558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist