Provider Demographics
NPI:1992850713
Name:LINDBERG, DAVID J (MS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LINDBERG
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ELIZAVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-1140
Mailing Address - Country:US
Mailing Address - Phone:606-849-2212
Mailing Address - Fax:606-849-2242
Practice Address - Street 1:610 ELIZAVILLE AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1140
Practice Address - Country:US
Practice Address - Phone:606-849-2212
Practice Address - Fax:606-849-2242
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30608012Medicaid