Provider Demographics
NPI:1831623479
Name:PANCRATZ, LINDEN
Entity type:Individual
Prefix:
First Name:LINDEN
Middle Name:
Last Name:PANCRATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:PANCRATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 W PIKES PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1534
Mailing Address - Country:US
Mailing Address - Phone:719-696-9663
Mailing Address - Fax:
Practice Address - Street 1:10 BOULDER CRESCENT ST STE 300E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3367
Practice Address - Country:US
Practice Address - Phone:719-696-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015867101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health