Healthcare Provider Details

I. General information

NPI: 1164095295
Provider Name (Legal Business Name): INDIGO SKYE KOTVAL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: INDIGO SKYE LANKTON

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6206 W SAGINAW HWY STE B
LANSING MI
48917-2496
US

IV. Provider business mailing address

2416 TWILIGHT ST
JACKSON MI
49203-3717
US

V. Phone/Fax

Practice location:
  • Phone: 517-974-8420
  • Fax:
Mailing address:
  • Phone: 517-974-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401223713
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: