Provider Demographics
NPI:1508975467
Name:LINDSTROM, BARRY R (PHD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:R
Last Name:LINDSTROM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 W 20TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6565
Mailing Address - Country:US
Mailing Address - Phone:970-356-3100
Mailing Address - Fax:970-356-4827
Practice Address - Street 1:3211 W 20TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6565
Practice Address - Country:US
Practice Address - Phone:970-356-3100
Practice Address - Fax:970-356-4827
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1303103TC0700X, 103TC2200X
CO0308917103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO060747OtherVALUE OPTIONS
CO07013030Medicaid
CO643344OtherBLUE CROSS
CO060747OtherVALUE OPTIONS