Provider Demographics
NPI:1912323908
Name:KREIDLER, LYNETTE MARIE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:MARIE
Last Name:KREIDLER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N MILLER RD STE 450
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3770
Mailing Address - Country:US
Mailing Address - Phone:330-705-9521
Mailing Address - Fax:330-705-9521
Practice Address - Street 1:150 N MILLER RD STE 450
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3770
Practice Address - Country:US
Practice Address - Phone:330-705-9521
Practice Address - Fax:330-705-9521
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1800662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1912323908Medicaid