Provider Demographics
NPI:1952450595
Name:LINTON, JEREMY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:M
Last Name:LINTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 IRONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1888
Mailing Address - Country:US
Mailing Address - Phone:574-273-2743
Mailing Address - Fax:574-273-2746
Practice Address - Street 1:2012 IRONWOOD CIR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1888
Practice Address - Country:US
Practice Address - Phone:574-273-2743
Practice Address - Fax:574-273-2746
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001667A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health