Provider Demographics
NPI:1063445120
Name:HOLSENBECK, LINTON STEPHEN III (MD)
Entity Type:Individual
Prefix:DR
First Name:LINTON
Middle Name:STEPHEN
Last Name:HOLSENBECK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 ANGEL TER
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4712
Mailing Address - Country:US
Mailing Address - Phone:719-660-2510
Mailing Address - Fax:
Practice Address - Street 1:3115 ANGEL TER
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-4712
Practice Address - Country:US
Practice Address - Phone:719-660-2510
Practice Address - Fax:719-538-1460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO243702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01243708Medicaid
CO01243708Medicaid