Provider Demographics
NPI:1235905894
Name:PEDERSEN, TROY (JD, LMHC, LPCC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:JD, LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:IN
Mailing Address - Zip Code:46120-9606
Mailing Address - Country:US
Mailing Address - Phone:317-408-8968
Mailing Address - Fax:
Practice Address - Street 1:409 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:IN
Practice Address - Zip Code:46120-9606
Practice Address - Country:US
Practice Address - Phone:317-408-8968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104058101YP2500X
IN39000352A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional