Provider Demographics
NPI:1497002786
Name:BLACKWELDER, LYNDA LAWRENCE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:LAWRENCE
Last Name:BLACKWELDER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 STATESMEN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5646
Mailing Address - Country:US
Mailing Address - Phone:317-513-6181
Mailing Address - Fax:317-863-2620
Practice Address - Street 1:4735 STATESMEN DR
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5646
Practice Address - Country:US
Practice Address - Phone:317-513-6181
Practice Address - Fax:317-863-2620
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001642A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist