Provider Demographics
NPI:1386700045
Name:SCHRENK, LINDA (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:SCHRENK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:SCHRENK
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7863 LA MESA BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941
Mailing Address - Country:US
Mailing Address - Phone:619-698-9525
Mailing Address - Fax:619-698-9546
Practice Address - Street 1:7863 LA MESA BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941
Practice Address - Country:US
Practice Address - Phone:619-698-9525
Practice Address - Fax:619-698-9546
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12152103TC0700X
CAMFC23179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY12152Medicaid
CAPSY12152Medicaid
CP12152Medicare UPIN
CACP12152Medicare ID - Type Unspecified