Basic Information
| Provider Information | |||||||||
| NPI: | 1306983283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | APCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58945 BUSINESS CENTER DR STE D | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922847310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602289657 | ||||||||
| FaxNumber: | 7603652072 | ||||||||
| Practice Location | |||||||||
| Address1: | 58945 BUSINESS CENTER DR STE D | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922847310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602289657 | ||||||||
| FaxNumber: | 7603652072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 03/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4841 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | APCC4841 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1306983283 | 05 | CA | MEDICAID |