Active NPI
Lyndon Scott Fluegel
- Mental Health Counselor
- Davenport, IA
National Provider Identifier
1154773430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 072963
- Practice address
- 2028 E 38TH St
Davenport, IA 52807-1168 - Phone
- (563) 424-2016
- Fax
- (563) 424-2017
- NPI assigned
- Jul 11, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 072963 | IA | Primary |
Addresses
Primary practice location
2028 E 38TH St
Davenport, IA 52807-1168
Mailing address
2028 E 38TH St
Davenport, IA 52807-1168
Phone (563) 424-2016
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 072963 | IA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kivisto Counseling and Therapy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Bettendorf, IA
- NPI 1659991610
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468195200000",
"number": "1154773430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2028 E 38TH ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528071168",
"telephone_number": "563-424-2016",
"fax_number": "563-424-2017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2028 E 38TH ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528071168",
"telephone_number": "563-424-2016",
"fax_number": "563-424-2017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLUEGEL",
"first_name": "LYNDON",
"middle_name": "SCOTT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-11",
"last_updated": "2016-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IA",
"license": "072963",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.