Basic Information
| Provider Information | |||||||||
| NPI: | 1104248418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONDEREE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 W BROAD ST LOWER | ||||||||
| Address2: | LIGHTS CHRISTIAN HEALTH CENTER | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142741455 | ||||||||
| FaxNumber: | 6142741433 | ||||||||
| Practice Location | |||||||||
| Address1: | 1160 W BROAD ST | ||||||||
| Address2: | LOWER LIGHTS CHRISTIAN HEALTH CENTER | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432221317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142741455 | ||||||||
| FaxNumber: | 6142741433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2014 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C.1200194 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.