Healthcare Provider Details

I. General information

NPI: 1851160113
Provider Name (Legal Business Name): LUKE BALOGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BLAZIER DR
WEXFORD PA
15090-9508
US

IV. Provider business mailing address

2403 S BRADDOCK AVE
PITTSBURGH PA
15218-2244
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020192
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: