Provider Demographics
NPI:1760505895
Name:GARY, LINDA ANN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:GARY
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 1:23123 VENTURA BLVD.
Mailing Address - Street 2:106
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1166
Mailing Address - Country:US
Mailing Address - Phone:818-917-7600
Mailing Address - Fax:818-999-4249
Practice Address - Street 1:23123 VENTURA BLVD.
Practice Address - Street 2:106
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1166
Practice Address - Country:US
Practice Address - Phone:818-917-7600
Practice Address - Fax:818-999-4249
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist