Healthcare Provider Details

I. General information

NPI: 1477110658
Provider Name (Legal Business Name): MCLOUGHLIN CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S MCCORMICK ST STE 2
PRESCOTT AZ
86303-4738
US

IV. Provider business mailing address

153 S LYNX CREEK RD
PRESCOTT AZ
86303-6815
US

V. Phone/Fax

Practice location:
  • Phone: 928-308-8645
  • Fax:
Mailing address:
  • Phone: 928-308-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SEAN MCLOUGHLIN
Title or Position: OWNER
Credential: LPC
Phone: 928-308-8645