Provider Demographics
NPI:1124564638
Name:HARTZLER, LYDIA (LPC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HARTZLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7567 CENTRAL PARKE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7567 CENTRAL PARKE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6852
Practice Address - Country:US
Practice Address - Phone:513-770-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health