Provider Demographics
NPI:1851821722
Name:LUECK, IZABELA MALGORZATA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:IZABELA
Middle Name:MALGORZATA
Last Name:LUECK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:PROF
Other - First Name:IZABELA
Other - Middle Name:MALGORZATA
Other - Last Name:PYTLAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:20290 DRUMMOND BAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1467
Mailing Address - Country:US
Mailing Address - Phone:586-201-0736
Mailing Address - Fax:
Practice Address - Street 1:1424 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2026
Practice Address - Country:US
Practice Address - Phone:248-548-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017598101YM0800X
MI6401016125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health