Healthcare Provider Details

I. General information

NPI: 1194582361
Provider Name (Legal Business Name): LYNDON CORDE FOUNDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LYNDON CORDE LYNDON CORDE

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 S JAMES RD
COLUMBUS OH
43213-1621
US

IV. Provider business mailing address

46 S JAMES RD
COLUMBUS OH
43213-1621
US

V. Phone/Fax

Practice location:
  • Phone: 614-405-4476
  • Fax:
Mailing address:
  • Phone: 614-405-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: