MEDICARE: DR. LISA MARIE LINNING PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY 0580	NV

General Provider Information

NPI Number	:	1235434242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE LINNING PH.D.

Provider Business Mailing Address
First Line	:	3100 W SAHARA AVE STE 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-6008
Country	:	US
Telephone Number	:	702-860-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 PASEO DEL PRADO STE D307
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4342
Country	:	US
Telephone Number	:	702-860-3305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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