Provider Demographics
NPI:1346360401
Name:KELLEEN M LINDEN PHD PA
Entity Type:Organization
Organization Name:KELLEEN M LINDEN PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:239-454-3655
Mailing Address - Street 1:1705 COLONIAL BLVD A-4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-454-3655
Mailing Address - Fax:239-454-3655
Practice Address - Street 1:1705 COLONIAL BLVD A-4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-454-3655
Practice Address - Fax:239-454-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3014101YM0800X
FLMT1455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty