MEDICARE: MR. JOSIAH S HARLAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC0013120	CO

General Provider Information

NPI Number	:	1649597493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSIAH S HARLAN LPC

Provider Business Mailing Address
First Line	:	185 SUTTLE ST
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81303-8276
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 LAKE FOREST CIR
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147
Country	:	US
Telephone Number	:	409-201-6136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	06/21/2018

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