Healthcare Provider Details

I. General information

NPI: 1952875577
Provider Name (Legal Business Name): SEAN JAMES MCLOUGHLIN MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
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 Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-17997
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-17997
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: