Provider Demographics
NPI:1447641972
Name:PEDIGO, MICHAEL (LPCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PEDIGO
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17354
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-0354
Mailing Address - Country:US
Mailing Address - Phone:502-813-9570
Mailing Address - Fax:
Practice Address - Street 1:1103 DELOR AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-2226
Practice Address - Country:US
Practice Address - Phone:502-813-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00216616101YP2500X
KY248063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional