Provider Demographics
NPI:1598712630
Name:SHAKE, LINDA M (MS,LPC,LMFT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:SHAKE
Suffix:
Gender:F
Credentials:MS,LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 S STAPLES ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3842
Mailing Address - Country:US
Mailing Address - Phone:361-985-1541
Mailing Address - Fax:361-985-2065
Practice Address - Street 1:5934 S STAPLES ST
Practice Address - Street 2:SUITE 230
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3842
Practice Address - Country:US
Practice Address - Phone:361-985-1541
Practice Address - Fax:361-985-2065
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10213101YP2500X
TX003282-041169106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2158LCOtherBLUE CROSS BLUE SHIELD TX
TX2271938OtherFIRST HEALTH