Provider Demographics
NPI:1811034762
Name:MCPHERSON, LINDA SUE (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 N SHADELAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2691
Mailing Address - Country:US
Mailing Address - Phone:317-588-7130
Mailing Address - Fax:317-588-7150
Practice Address - Street 1:7950 N SHADELAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2691
Practice Address - Country:US
Practice Address - Phone:317-588-7130
Practice Address - Fax:317-588-7150
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040884A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN521150GMedicare ID - Type Unspecified
INS11246Medicare UPIN