Provider Demographics
NPI:1316189491
Name:LINDEN-JOHNSON, MICHAELE DAWN (LCSW, FACHE)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELE
Middle Name:DAWN
Last Name:LINDEN-JOHNSON
Suffix:
Gender:F
Credentials:LCSW, FACHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 REMINGTON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3074
Mailing Address - Country:US
Mailing Address - Phone:915-247-7862
Mailing Address - Fax:
Practice Address - Street 1:503 REMINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3074
Practice Address - Country:US
Practice Address - Phone:970-214-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992151101YM0800X
TX62691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS16939Medicare UPIN