Provider Demographics
NPI:1205363009
Name:LIND LEANDER, KATHLEEN KIMBERLY (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KIMBERLY
Last Name:LIND LEANDER
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 1:6255 DERBY ROCK LOOP
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6255 DERBY ROCK LOOP
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2838
Practice Address - Country:US
Practice Address - Phone:719-649-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5628101YA0400X, 101YM0800X
CO061401146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate