Provider Demographics
NPI:1891025607
Name:LINDENTHALER, HOLLY (LPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:LINDENTHALER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 VISTA DEL COLLADOS
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-4822
Mailing Address - Country:US
Mailing Address - Phone:805-544-0626
Mailing Address - Fax:
Practice Address - Street 1:1012 VISTA DEL COLLADOS
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-4822
Practice Address - Country:US
Practice Address - Phone:805-544-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18273167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician