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General NPI Number Information
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NPI Number | 1154652931
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Entity Type | Individual
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Provider Name | LINDA CLAIRE CLOSE M.ED., L.M.H.C.
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Gender | Female
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 6521 ORANGE DR
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City | DAVIE
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State | FL
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Zip | 33314-3340
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Country | US
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Telephone | 954-579-3036
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Fax |
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Provider Business Mailing Address
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Address Line | 20757 NW 9TH CT APT. 107
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-6811
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Country | US
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Telephone | 954-579-3036
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 10035
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License Number State | FL
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