=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316465412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINEBARGER & ASSOCIATES, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2017
-----------------------------------------------------
Last Update Date | 01/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1417 S FAIRFAX ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80222-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-474-0025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1417 S FAIRFAX ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80222-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-474-0025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LAURA LINEBARGER
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 773-474-0025
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071009203
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------