Provider Demographics
NPI:1871635912
Name:CALVERT, LINDA (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CALVERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FM 3237 STE F
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5371
Mailing Address - Country:US
Mailing Address - Phone:512-847-9992
Mailing Address - Fax:
Practice Address - Street 1:101 FM 3237 STE F
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5371
Practice Address - Country:US
Practice Address - Phone:512-847-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036KXOtherBLUECROSS BLUESHIELD
TX00322PMedicare ID - Type Unspecified