Provider Demographics
NPI:1609405240
Name:TERVOLA, LUKE ABRAHAM
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:ABRAHAM
Last Name:TERVOLA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W 4TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-2719
Mailing Address - Country:US
Mailing Address - Phone:218-640-1027
Mailing Address - Fax:
Practice Address - Street 1:221 W 4TH ST STE 300
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-2719
Practice Address - Country:US
Practice Address - Phone:218-640-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical