MEDICARE: LINDSAY ANN BACK LPCC-S

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	E.0600276	OH
2	101YM0800X	Mental Health Counselor	E.0600276-SUPV	OH

General Provider Information

NPI Number	:	1386803229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY ANN BACK LPCC-S

Provider Business Mailing Address
First Line	:	8809B CINCINNATI DAYTON RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3134
Country	:	US
Telephone Number	:	937-219-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	8809B CINCINNATI DAYTON RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3134
Country	:	US
Telephone Number	:	937-219-7770
Fax Number	:	513-868-3249

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	05/22/2024

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