Provider Demographics
NPI:1679608871
Name:MICHAEL, LINDA S (PSY D)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 LAKE BLVD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2614
Mailing Address - Country:US
Mailing Address - Phone:510-847-2982
Mailing Address - Fax:
Practice Address - Street 1:1260 LAKE BLVD
Practice Address - Street 2:SUITE 224
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-2614
Practice Address - Country:US
Practice Address - Phone:510-847-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical