Healthcare Provider Details

I. General information

NPI: 1811572373
Provider Name (Legal Business Name): TODD W LINDSLEY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 ETNA RD STE 350
LEBANON NH
03766-1497
US

IV. Provider business mailing address

67 ETNA RD STE 350
LEBANON NH
03766-1497
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-0055
  • Fax: 603-790-8442
Mailing address:
  • Phone: 603-448-0055
  • Fax: 603-790-8442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1396
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: