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NPI Code Detail

MEDICARE: LOUKAS NICHOLAS KONDYLES LIMITED LICENSE COUN

MEDICARE: LOUKAS NICHOLAS KONDYLES LIMITED LICENSE COUN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor6451023661MI

General Provider Information

NPI Number : 1396226312
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOUKAS NICHOLAS KONDYLES LIMITED LICENSE COUN
Provider Business Mailing Address
First Line : 331 EUREKA AVE SE UPPR
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-1503
Country : US
Telephone Number : 616-259-4462
Fax Number : 616-828-1936
Provider Business Practice Location Address
First Line : 781 KENMOOR AVE SE STE C
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8624
Country : US
Telephone Number : 616-259-4462
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2018
Last Update Date : 03/10/2026

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Directions to “ LOUKAS NICHOLAS KONDYLES LIMITED LICENSE COUN” Practice Location

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