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General NPI Number Information
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NPI Number | 1568719854
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Entity Type | Organization
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Legal Business Name | LYNDA L. BLACKWELDER, LLC
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/03/2013
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Provider Practice Location Address
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Address Line | 4735 STATESMEN DR. SUITE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46250
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Country | US
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Telephone | 317-513-6181
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Fax | 317-863-2620
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Provider Business Mailing Address
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Address Line | 4302 HEYWARD PL
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-4286
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Country | US
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Telephone | 317-513-6181
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Fax | 317-863-2620
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. LYNDA LAWRENCE BLACKWELDER
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Credential | LMFT
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Telephone | 317-513-6181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001642A
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License Number State | IN
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