Provider Demographics
NPI:1992418024
Name:LUKE BURGDORF COUNSELING LLC
Entity type:Organization
Organization Name:LUKE BURGDORF COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-348-5068
Mailing Address - Street 1:2616 OUTLOOK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4228
Mailing Address - Country:US
Mailing Address - Phone:269-348-5068
Mailing Address - Fax:
Practice Address - Street 1:2616 OUTLOOK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4228
Practice Address - Country:US
Practice Address - Phone:269-348-5068
Practice Address - Fax:269-666-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty