Provider Demographics
NPI:1881688919
Name:LOFGREEN, DEREK TODD (LPC)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:TODD
Last Name:LOFGREEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 N ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-4016
Mailing Address - Country:US
Mailing Address - Phone:602-779-4325
Mailing Address - Fax:480-926-8985
Practice Address - Street 1:2650 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5413
Practice Address - Country:US
Practice Address - Phone:602-779-4325
Practice Address - Fax:480-926-8985
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional