Healthcare Provider Details

I. General information

NPI: 1578076584
Provider Name (Legal Business Name): LINDSEY DISTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37606 SHARPE AVE
WILLOUGHBY OH
44094-6017
US

IV. Provider business mailing address

37606 SHARPE AVE
WILLOUGHBY OH
44094-6017
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-8667
  • Fax:
Mailing address:
  • Phone: 970-668-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1800880
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016811
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: