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General NPI Number Information
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NPI Number | 1275978512
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Entity Type | Organization
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Legal Business Name | PEDERSEN COUNSELING
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 405 N LEXINGTON AVE
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City | WILMORE
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State | KY
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Zip | 40390-1195
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Country | US
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Telephone | 317-408-8968
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Fax |
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Provider Business Mailing Address
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Address Line | 405 N LEXINGTON AVE
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City | WILMORE
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State | KY
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Zip | 40390-1195
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Country | US
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Telephone | 317-408-8968
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | TROY N PEDERSEN
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Credential | LPCA
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Telephone | 317-408-8968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | KY-1573
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License Number State | KY
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