Provider Demographics
NPI:1992824817
Name:CLINE, LINDA LORENE (MED, MS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LORENE
Last Name:CLINE
Suffix:
Gender:F
Credentials:MED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 N 21ST ST
Mailing Address - Street 2:UNIT 47
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5552
Mailing Address - Country:US
Mailing Address - Phone:623-691-4418
Mailing Address - Fax:623-691-4420
Practice Address - Street 1:3201 N 46TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3707
Practice Address - Country:US
Practice Address - Phone:623-691-4418
Practice Address - Fax:623-691-4420
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26052103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ875205Medicaid