Provider Demographics
NPI:1023300324
Name:LINDSTROM, CATHERINE (PHD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 N 147TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8947
Mailing Address - Country:US
Mailing Address - Phone:602-309-0403
Mailing Address - Fax:602-995-5740
Practice Address - Street 1:1668 W GLENDALE AVE
Practice Address - Street 2:STE. 128
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8971
Practice Address - Country:US
Practice Address - Phone:602-544-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ148371OtherPTAN