=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801661160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISHA KATHLEEN LINDER LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2023
-----------------------------------------------------
Last Update Date | 11/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4801 S LAKESHORE DR STE 111
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-7156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-359-5859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2014 S ILLINOIS PL
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85286-7789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-326-9446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LAC-22541
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------