Individual
MICHAEL CHARLES LUXEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1210 1ST ST W, HASTINGS, MN 55033-1147
(651) 438-1800
Mailing address
1210 1ST ST W, HASTINGS, MN 55033-1147
(651) 438-1800
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
2707-057
WI
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
LP 4843
MN
Other
Enumeration date
04/29/2009
Last updated
04/29/2009
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