Provider Demographics
NPI:1336155324
Name:LINDHOLM, JAN (LMHC, CDP, LRCP)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:
Last Name:LINDHOLM
Suffix:
Gender:F
Credentials:LMHC, CDP, LRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3053
Mailing Address - Country:US
Mailing Address - Phone:253-853-7971
Mailing Address - Fax:253-848-5700
Practice Address - Street 1:400 E PIONEER
Practice Address - Street 2:SUITE 200
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3255
Practice Address - Country:US
Practice Address - Phone:253-279-7509
Practice Address - Fax:253-848-5700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004558101Y00000X
WACP00002076101YA0400X
WALR 00000696227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered