Healthcare Provider Details

I. General information

NPI: 1225480239
Provider Name (Legal Business Name): GINA TOURANGEAU LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ACADEMY HILL RD
PLAINFIELD CT
06374-1600
US

IV. Provider business mailing address

154 EDMOND RD
GRISWOLD CT
06351-1514
US

V. Phone/Fax

Practice location:
  • Phone: 860-917-9559
  • Fax:
Mailing address:
  • Phone: 860-917-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2928
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: