Provider Demographics
NPI:1295883346
Name:SIRCUS, LINDA (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:SIRCUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:NOSANCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:26111 W 14 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1170
Mailing Address - Country:US
Mailing Address - Phone:248-310-4598
Mailing Address - Fax:248-310-4598
Practice Address - Street 1:26111 W 14 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1170
Practice Address - Country:US
Practice Address - Phone:248-310-4598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007420103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist