Provider Demographics
NPI:1639422553
Name:GREEN-BASKETT, LINDA J (LMHC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:GREEN-BASKETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 EASTBROOK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5744
Mailing Address - Country:US
Mailing Address - Phone:970-500-0164
Mailing Address - Fax:801-966-4289
Practice Address - Street 1:3351 EASTBROOK DR STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5744
Practice Address - Country:US
Practice Address - Phone:970-500-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8627168-6004101YP2500X
COLPC0019425101YP2500X
WALH00006181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional