Healthcare Provider Details

I. General information

NPI: 1104742956
Provider Name (Legal Business Name): LENA ETZEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 SAWMILL PKWY STE 2B
POWELL OH
43065-7828
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-4969
  • Fax: 614-293-6111
Mailing address:
  • Phone: 614-293-4969
  • Fax: 614-293-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.09012
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: