Provider Demographics
NPI:1154113132
Name:ELIZONDO-LYNDAKER, TANYA (MA, NCC, RIC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ELIZONDO-LYNDAKER
Suffix:
Gender:F
Credentials:MA, NCC, RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13518 ORCHARD WOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-7900
Mailing Address - Country:US
Mailing Address - Phone:315-489-1418
Mailing Address - Fax:
Practice Address - Street 1:13518 ORCHARD WOOD CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-7900
Practice Address - Country:US
Practice Address - Phone:315-489-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health