=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659394278
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA J CHARKINS LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 07/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 537 CAJON ST
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-798-7267
-----------------------------------------------------
Fax | 760-249-5748
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 934
-----------------------------------------------------
City | WRIGHTWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92397-0934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-798-7267
-----------------------------------------------------
Fax | 760-249-5058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC22650
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT22650
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------