Provider Demographics
NPI:1568719854
Name:LYNDA L. BLACKWELDER, LLC
Entity Type:Organization
Organization Name:LYNDA L. BLACKWELDER, LLC
Other - Org Name:WEST CLAY COUNSELING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BLACKWELDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:317-513-6181
Mailing Address - Street 1:4302 HEYWARD PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4286
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
Practice Address - Country:US
Practice Address - Phone:317-513-6181
Practice Address - Fax:317-863-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001642A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty