Healthcare Provider Details

I. General information

NPI: 1457815912
Provider Name (Legal Business Name): ADAN LIENDO PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4629 AICHOLTZ RD
CINCINNATI OH
45244
US

IV. Provider business mailing address

4633 AICHOLTZ RD
CINCINNATI OH
45244-1447
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone: 956-740-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1901780
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018043307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: