Healthcare Provider Details

I. General information

NPI: 1689596546
Provider Name (Legal Business Name): FREDRICKSON LOPEZ COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 MASSACHUSETTS ST UNIT 123
LAWRENCE KS
66044-2345
US

IV. Provider business mailing address

2533 RIDGE CT
LAWRENCE KS
66046-4080
US

V. Phone/Fax

Practice location:
  • Phone: 785-201-9337
  • Fax:
Mailing address:
  • Phone: 782-201-9337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. NATHAN PAUL FREDRICKSON
Title or Position: OWNER
Credential: LMSW
Phone: 785-201-9337