Healthcare Provider Details

I. General information

NPI: 1013103068
Provider Name (Legal Business Name): LINDA J. MARCOUX EDDCP, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23451 CREST FOREST DR.
CRESTLINE CA
92325
US

IV. Provider business mailing address

18031 US HIGHWAY 18 STE E
APPLE VALLEY CA
92307-2152
US

V. Phone/Fax

Practice location:
  • Phone: 760-961-7733
  • Fax: 760-961-7733
Mailing address:
  • Phone: 760-961-7733
  • Fax: 760-961-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC47598
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 47598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: