=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659185064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENEATH THE LINDEN TREE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2025
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3804 S ELM ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80237-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-420-2081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3804 S ELM ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80237-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-420-2081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | SYDNEY HALL LINDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-420-2081
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------