Provider Demographics
NPI:1487911020
Name:LINDA THIBAULT, PSY. D., LP, PLLC
Entity type:Organization
Organization Name:LINDA THIBAULT, PSY. D., LP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIBAULT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:734-657-8443
Mailing Address - Street 1:20793 FARMINGTON RD
Mailing Address - Street 2:SUITE #17
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5182
Mailing Address - Country:US
Mailing Address - Phone:734-657-8443
Mailing Address - Fax:
Practice Address - Street 1:20793 FARMINGTON RD
Practice Address - Street 2:SUITE #17
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5182
Practice Address - Country:US
Practice Address - Phone:734-657-8443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014245261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health