Healthcare Provider Details

I. General information

NPI: 1710625199
Provider Name (Legal Business Name): JOSHUA LINDHOLM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 AMERICAN AVE
KING OF PRUSSIA PA
19406-4023
US

IV. Provider business mailing address

108 MIDDLETON LN
CLOVIS NM
88101-8049
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 303-416-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS025021
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number347231
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO2026-0199
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: