Provider Demographics
| NPI: | 1487909933 |
|---|---|
| Name: | LINDA L THEDE PC |
| Entity type: | Organization |
| Organization Name: | LINDA L THEDE PC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO/PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | LINDA |
| Authorized Official - Middle Name: | LOUISE |
| Authorized Official - Last Name: | THEDE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PSYD |
| Authorized Official - Phone: | 719-473-9200 |
| Mailing Address - Street 1: | 8415 TIAGA TRL |
| Mailing Address - Street 2: | |
| Mailing Address - City: | COLORADO SPRINGS |
| Mailing Address - State: | CO |
| Mailing Address - Zip Code: | 80919-4531 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 719-473-9200 |
| Mailing Address - Fax: | 719-473-9203 |
| Practice Address - Street 1: | 8415 TIAGA TRL |
| Practice Address - Street 2: | |
| Practice Address - City: | COLORADO SPRINGS |
| Practice Address - State: | CO |
| Practice Address - Zip Code: | 80919-4531 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 719-473-9200 |
| Practice Address - Fax: | 719-473-9203 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2012-07-20 |
| Last Update Date: | 2020-08-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | Group - Multi-Specialty | |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CO | 1497904908 | Other | INDIVIDUAL NPI |
