MEDICARE: LINDSAY C IBOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C.2103680-TRNE	OH

General Provider Information

NPI Number	:	1366198848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY C IBOS

Provider Business Mailing Address
First Line	:	803 GRANT AVE
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-4607
Country	:	US
Telephone Number	:	440-334-8457
Fax Number	:

Provider Business Practice Location Address
First Line	:	3757 FISHCREEK RD
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-5404
Country	:	US
Telephone Number	:	234-529-1994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	02/23/2022

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Directions to “ LINDSAY C IBOS ” Practice Location

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