Provider Demographics
NPI:1629378658
Name:LONDON, LINDSAY (LMHC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3034
Mailing Address - Country:US
Mailing Address - Phone:574-287-4197
Mailing Address - Fax:574-287-4393
Practice Address - Street 1:3516 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3034
Practice Address - Country:US
Practice Address - Phone:574-287-4197
Practice Address - Fax:574-287-4393
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002344A101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health