Provider Demographics
NPI:1396919981
Name:LINDA M. SHAKE & ASSOCIATES, INC.
Entity type:Organization
Organization Name:LINDA M. SHAKE & ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:361-985-1541
Mailing Address - Street 1:5934 S STAPLES ST
Mailing Address - Street 2:STE. 230
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3842
Mailing Address - Country:US
Mailing Address - Phone:361-985-1541
Mailing Address - Fax:361-985-2065
Practice Address - Street 1:5934 S STAPLES ST
Practice Address - Street 2:STE. 230
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3842
Practice Address - Country:US
Practice Address - Phone:361-985-1541
Practice Address - Fax:361-985-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2652101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty