Healthcare Provider Details

I. General information

NPI: 1073564449
Provider Name (Legal Business Name): LYNDA M SNELLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 DUPONT CIRCLE SUITE A
MILFORD OH
45150-9607
US

IV. Provider business mailing address

218 STERN RD
SEAMAN OH
45679-9607
US

V. Phone/Fax

Practice location:
  • Phone: 513-576-7700
  • Fax: 513-576-1020
Mailing address:
  • Phone: 937-386-1379
  • Fax: 937-386-0129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI0004900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: