Healthcare Provider Details

I. General information

NPI: 1952943284
Provider Name (Legal Business Name): SAGAMORE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 STATE RD
SAGAMORE BEACH MA
02562-2317
US

IV. Provider business mailing address

2 PAWTUXET RD
PLYMOUTH MA
02360-8003
US

V. Phone/Fax

Practice location:
  • Phone: 508-333-1375
  • Fax:
Mailing address:
  • Phone: 801-678-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYCIA E JURGELA
Title or Position: MANAGER
Credential: LPC
Phone: 801-678-3317