Provider Demographics
NPI:1962693408
Name:MAYSHACK, LINDA GAIL (LMSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:GAIL
Last Name:MAYSHACK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12630 ASHFORD POINT DR APT 206
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-5422
Mailing Address - Country:US
Mailing Address - Phone:713-550-7892
Mailing Address - Fax:
Practice Address - Street 1:12630 ASHFORD POINT DR APT 206
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-5422
Practice Address - Country:US
Practice Address - Phone:713-550-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24388104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
02261959OtherDOB