Provider Demographics
NPI:1063889269
Name:LITTLE, LINDA FAYE (PHD PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:FAYE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 MCMINN RD
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-9005
Mailing Address - Country:US
Mailing Address - Phone:360-385-7459
Mailing Address - Fax:
Practice Address - Street 1:780 MCMINN RD
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9005
Practice Address - Country:US
Practice Address - Phone:360-385-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60468249103TC0700X
WA.PY60468249103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily