Healthcare Provider Details

I. General information

NPI: 1821536335
Provider Name (Legal Business Name): VANESSA EILEEN PUGH LMHC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 MAGNOLIA CT
BETTENDORF IA
52722-2364
US

IV. Provider business mailing address

3225 MAGNOLIA CT
BETTENDORF IA
52722-2364
US

V. Phone/Fax

Practice location:
  • Phone: 563-940-6153
  • Fax:
Mailing address:
  • Phone: 563-940-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number098859
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.013643
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: