Provider Demographics
NPI:1689255754
Name:MACINNES, LINDA A
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:MACINNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26900 WINCHESTER CREEK AVE APT 4202
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4105
Mailing Address - Country:US
Mailing Address - Phone:951-551-5437
Mailing Address - Fax:
Practice Address - Street 1:29995 TECHNOLOGY DR STE 304
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2634
Practice Address - Country:US
Practice Address - Phone:951-990-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist