Provider Demographics
NPI:1669555371
Name:LINDT, JOHN R (MA, MDIV, LMFT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:LINDT
Suffix:
Gender:M
Credentials:MA, MDIV, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-2194
Mailing Address - Country:US
Mailing Address - Phone:906-863-5646
Mailing Address - Fax:906-863-1078
Practice Address - Street 1:2012 10TH ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-2194
Practice Address - Country:US
Practice Address - Phone:906-863-5646
Practice Address - Fax:906-863-1078
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006223101YM0800X
WI628 124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health