Provider Demographics
NPI:1013064674
Name:LINDA C DANIELS PHD LLC
Entity Type:Organization
Organization Name:LINDA C DANIELS PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-528-6166
Mailing Address - Street 1:1990 E LOHMAN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3172
Mailing Address - Country:US
Mailing Address - Phone:575-528-6166
Mailing Address - Fax:
Practice Address - Street 1:1990 E LOHMAN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3172
Practice Address - Country:US
Practice Address - Phone:575-528-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN7425Medicaid
NMN7425Medicaid
NM300521147Medicare PIN