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General NPI Number Information
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NPI Number | 1497076749
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Entity Type | Organization
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Legal Business Name | DAVID N LOMBARD, PH.D, LLC
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 06/21/2010
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Provider Practice Location Address
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Address Line | 3242 MALLARD COVE LN
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City | FORT WAYNE
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State | IN
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Zip | 46804-2883
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Country | US
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Telephone | 260-459-2900
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Fax | 260-459-2901
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Provider Business Mailing Address
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Address Line | 3242 MALLARD COVE LN
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City | FORT WAYNE
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State | IN
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Zip | 46804-2883
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Country | US
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Telephone | 260-459-2900
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Fax | 260-459-2901
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DAVID N LOMBARD
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Credential | PH.D
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Telephone | 260-459-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 20041481A
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License Number State | IN
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