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Organization

PEDERSEN COUNSELING PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KELLY L PEDERSEN LPC-S (OWNER/PSYCHOTHERAPIST)
(512) 963-3660
Entity
Organization

Contact information

Practice address
317 COPPERLEAF RD, LAKEWAY, TX 78734-4246
(512) 963-3660
Mailing address
317 COPPERLEAF RD, LAKEWAY, TX 78734-4246
(512) 963-3660

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101YP2500X
TX
01
1497872493
MY NPI TYPE 1 NUMBER - SOLE PRORIETOR
TX
Enumeration date
06/12/2022
Last updated
06/12/2022
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