Healthcare Provider Details

I. General information

NPI: 1831051978
Provider Name (Legal Business Name): LINDY VAN KOMEN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 YANKEE ST
CENTERVILLE OH
45458-3574
US

IV. Provider business mailing address

3206 S BEECHGROVE RD
WILMINGTON OH
45177-9105
US

V. Phone/Fax

Practice location:
  • Phone: 513-274-3336
  • Fax:
Mailing address:
  • Phone: 513-274-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.2500470-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: