Provider Demographics
NPI:1235279621
Name:LINDQUIST, JOHN THEOPHILE (PHD LP)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THEOPHILE
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:PHD LP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:FIVE COUNTY MENTAL HEALTH CENTER
Mailing Address - Street 2:521 BROADWAY AVENUE NORTH PO BOX 287
Mailing Address - City:BRAHAM
Mailing Address - State:MN
Mailing Address - Zip Code:55006
Mailing Address - Country:US
Mailing Address - Phone:320-396-3333
Mailing Address - Fax:320-396-3363
Practice Address - Street 1:521 BROADWAY AVENUE NORTH
Practice Address - Street 2:FIVE COUNTY MENTAL HEALTH CENTER
Practice Address - City:BRAHAM
Practice Address - State:MN
Practice Address - Zip Code:55006
Practice Address - Country:US
Practice Address - Phone:320-396-3333
Practice Address - Fax:320-396-3363
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4385103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6140901OtherUBH
148M4LIOtherBCBS
1023485OtherPREFERRED ONE
HP37277OtherHEALTHPARTNERS
111284OtherOPTUM
P00026889OtherRAILROAD MEDICARE