Provider Demographics
NPI:1629734090
Name:LAGANGA, LINDA R (MA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:LAGANGA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4947
Mailing Address - Country:US
Mailing Address - Phone:720-352-6805
Mailing Address - Fax:
Practice Address - Street 1:2696 S COLORADO BLVD # 580
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5945
Practice Address - Country:US
Practice Address - Phone:720-352-6805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional