Basic Information
| Provider Information | |||||||||
| NPI: | 1093192460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWRENCE | ||||||||
| FirstName: | LENDOL | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 529 | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814250529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703236141 | ||||||||
| FaxNumber: | 8552998071 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 W 11TH ST | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708748981 | ||||||||
| FaxNumber: | 8552997586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LPC0012427 | WY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | LPC0012427 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.