Healthcare Provider Details

I. General information

NPI: 1346360401
Provider Name (Legal Business Name): KELLEEN M LINDEN PHD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 COLONIAL BLVD A-4
FORT MYERS FL
33907
US

IV. Provider business mailing address

1705 COLONIAL BLVD A-4
FORT MYERS FL
33907
US

V. Phone/Fax

Practice location:
  • Phone: 239-454-3655
  • Fax: 239-454-3655
Mailing address:
  • Phone: 239-454-3655
  • Fax: 239-454-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3014
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT1455
License Number StateFL

VIII. Authorized Official

Name: MRS. KELLEEN M LINDEN
Title or Position: PRESIDENT DIRECTOR
Credential: PHD
Phone: 239-454-3655