Provider Demographics
NPI:1679971337
Name:LUEDTKE, TIMOTHY (LCPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:LUEDTKE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 1/2 MASSACHUSETTS ST STE 213
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2257
Mailing Address - Country:US
Mailing Address - Phone:785-760-4810
Mailing Address - Fax:
Practice Address - Street 1:729 1/2 MASSACHUSETTS ST STE 213
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2257
Practice Address - Country:US
Practice Address - Phone:785-760-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1131101YA0400X
WYLAT-379101YA0400X
NE3388101YM0800X
NE10196101YM0800X
NE5212101YM0800X
KSLCPC03725101YM0800X
WYLPC-1748101YP2500X
KS03725101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional