MEDICARE: LGL CONSULTANT, LLC

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

General Provider Information

NPI Number	:	1902439086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LGL CONSULTANT, LLC

Provider Business Mailing Address
First Line	:	2456 MANOR WALK
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1625
Country	:	US
Telephone Number	:	404-971-1740
Fax Number	:

Provider Business Practice Location Address
First Line	:	2456 MANOR WALK
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1625
Country	:	US
Telephone Number	:	404-971-1740
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LUCILA GOICOCHEA DE LOPEZ
Credential	:	LPC
Telephone Number	:	404-971-1740

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	02/18/2020

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Directions to “LGL CONSULTANT, LLC ” Practice Location

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