Provider Demographics
NPI:1851411185
Name:HARRELL, LINDA (PSCHY TECH)
Entity Type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:PSCHY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 E FRANCES AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-6705
Mailing Address - Country:US
Mailing Address - Phone:559-685-1840
Mailing Address - Fax:
Practice Address - Street 1:1701 W KANAI AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1873
Practice Address - Country:US
Practice Address - Phone:559-782-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22833167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician