Provider Demographics
NPI:1124118070
Name:BAHRI, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BAHRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:HAILO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2703 RAVINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-5400
Mailing Address - Country:US
Mailing Address - Phone:248-252-6148
Mailing Address - Fax:
Practice Address - Street 1:1800 N MILFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1047
Practice Address - Country:US
Practice Address - Phone:248-684-6400
Practice Address - Fax:248-684-5973
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical