Doctor Name: | MICHAEL PEDIGO |
NPI Number: | 1447641972 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPCA |
License Number: | LPCCCA00216616 |
Business Practice Address: | 512 Bowling Green Rd Scottsville, KY - 42164 |
Business Phone Number: | 2709015000 |
Business Fax Number: | 2708425268 |
Mailing Address: | 380 Suwannee Trail St, BOWLING GREEN |
State: | KY |
Postal Code: | 421037956 |
Phone Number: | 2709015000 |
Fax Number: | 2708425268 |
NPI Enumeration Date: | 02/05/2015 |
NPI Last Update Date: | 02/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPCCCA00216616 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |