MEDICARE: LUKE ALLAN LCPC

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
1	101YM0800X	Mental Health Counselor	180.015928	IL

General Provider Information

NPI Number	:	1538936075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE ALLAN LCPC

Provider Business Mailing Address
First Line	:	535 EDWARDSVILLE RD STE 130
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294-1399
Country	:	US
Telephone Number	:	618-816-5050
Fax Number	:	844-927-4603

Provider Business Practice Location Address
First Line	:	535 EDWARDSVILLE RD STE 130
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294-1399
Country	:	US
Telephone Number	:	618-816-5050
Fax Number	:	844-927-4603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	09/09/2024

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Directions to “ LUKE ALLAN LCPC” Practice Location

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