Healthcare Provider Details

I. General information

NPI: 1497076749
Provider Name (Legal Business Name): DAVID N LOMBARD, PH.D, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3242 MALLARD COVE LN
FORT WAYNE IN
46804-2883
US

IV. Provider business mailing address

3242 MALLARD COVE LN
FORT WAYNE IN
46804-2883
US

V. Phone/Fax

Practice location:
  • Phone: 260-459-2900
  • Fax: 260-459-2901
Mailing address:
  • Phone: 260-459-2900
  • Fax: 260-459-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20041481A
License Number StateIN

VIII. Authorized Official

Name: DR. DAVID N LOMBARD
Title or Position: PRESIDENT/OWNER
Credential: PH.D
Phone: 260-459-2900