MEDICARE: LINDA DANIELS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	345	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NM00JS01	OTHER	NM	BCBS OF NM
3	202014609	OTHER	NM	PRESBYTERIAN HEALTH PLAN
4	VNM01373	OTHER	NM	VALUE OPTIONS OF NM

General Provider Information

NPI Number	:	1356359038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA DANIELS PH.D.

Provider Business Mailing Address
First Line	:	1990 E LOHMAN AVE
Second Line	:	SUITE #202
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3172
Country	:	US
Telephone Number	:	575-528-6166
Fax Number	:	575-524-6809

Provider Business Practice Location Address
First Line	:	1990 E LOHMAN AVE
Second Line	:	SUITE #202
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3172
Country	:	US
Telephone Number	:	575-528-6166
Fax Number	:	575-524-6809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	02/09/2023

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