Provider Demographics
NPI:1356359038
Name:DANIELS, LINDA (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DANIELS
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 1:1990 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:575-524-6809
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:575-524-6809
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN9840Medicaid
NMNM00JS01OtherBCBS OF NM
NM202014609OtherPRESBYTERIAN HEALTH PLAN
NMVNM01373OtherVALUE OPTIONS OF NM
NM343713103Medicare PIN