Healthcare Provider Details

I. General information

NPI: 1255118634
Provider Name (Legal Business Name): LYNLEA ELIZABETH CARDER MAC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 01/10/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 SOUTHWYCK BLVD STE 115
TOLEDO OH
43614-1510
US

IV. Provider business mailing address

5726 SOUTHWYCK BLVD STE 115
TOLEDO OH
43614-1510
US

V. Phone/Fax

Practice location:
  • Phone: 419-708-0441
  • Fax:
Mailing address:
  • Phone: 419-708-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: