Provider Demographics
NPI:1194090902
Name:LINDAU, JOHANNA KOVE (MA, LPC)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:KOVE
Last Name:LINDAU
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S CARR AVE W
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1024
Mailing Address - Country:US
Mailing Address - Phone:831-345-1430
Mailing Address - Fax:
Practice Address - Street 1:75 MANHATTAN DR STE 206
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4252
Practice Address - Country:US
Practice Address - Phone:831-345-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO0012041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86977253Medicaid