Healthcare Provider Details

I. General information

NPI: 1417719931
Provider Name (Legal Business Name): JUDY GAGNON COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MAIN ST STE 308
SPRINGVALE ME
04083-1872
US

IV. Provider business mailing address

64 MERCHANTS ROW
LEBANON ME
04027-4305
US

V. Phone/Fax

Practice location:
  • Phone: 207-698-0475
  • Fax: 207-850-1063
Mailing address:
  • Phone: 207-698-0475
  • Fax: 207-850-1063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JUDY GAGNON
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 207-698-0475