Provider Demographics
NPI:1790197580
Name:BERRY, LINDEN FARRAR (MFT (CA, 39,499))
Entity Type:Individual
Prefix:MS
First Name:LINDEN
Middle Name:FARRAR
Last Name:BERRY
Suffix:
Gender:F
Credentials:MFT (CA, 39,499)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2018
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911
Mailing Address - Country:US
Mailing Address - Phone:415-606-9793
Mailing Address - Fax:
Practice Address - Street 1:275 MILLER AVENUE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941
Practice Address - Country:US
Practice Address - Phone:415-606-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39,499106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist