Provider Demographics
NPI:1497904908
Name:THEDE, LINDA LOUISE (PSYD, LPC, LP)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LOUISE
Last Name:THEDE
Suffix:
Gender:F
Credentials:PSYD, LPC, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 TIAGA TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4531
Mailing Address - Country:US
Mailing Address - Phone:719-473-9200
Mailing Address - Fax:719-473-9203
Practice Address - Street 1:8415 TIAGA TRL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-4531
Practice Address - Country:US
Practice Address - Phone:719-473-9200
Practice Address - Fax:719-473-9203
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0005202101YP2500X
COPSY.0004148103TC0700X
CO5202103K00000X, 103T00000X, 103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30231582Medicaid
CO30231582Medicaid