Provider Demographics
NPI:1184323370
Name:LUKAS PEDERSON COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:LUKAS PEDERSON COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:269-873-5853
Mailing Address - Street 1:5065 STONEY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3843
Mailing Address - Country:US
Mailing Address - Phone:269-873-5853
Mailing Address - Fax:
Practice Address - Street 1:5985 W MAIN ST STE 804
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8708
Practice Address - Country:US
Practice Address - Phone:269-873-5853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)