Provider Demographics
NPI:1760942379
Name:LINTON, MICAH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:LINTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 CRESTMOORE PL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4814
Mailing Address - Country:US
Mailing Address - Phone:310-621-8203
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST STE 540
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2118
Practice Address - Country:US
Practice Address - Phone:310-582-7612
Practice Address - Fax:424-277-6342
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30784103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical