Healthcare Provider Details

I. General information

NPI: 1629404025
Provider Name (Legal Business Name): MAURA EAGAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 PIERCE DR
COLUMBUS OH
43223-2425
US

IV. Provider business mailing address

PO BOX 715194
COLUMBUS OH
43271-5194
US

V. Phone/Fax

Practice location:
  • Phone: 614-223-1650
  • Fax:
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001615
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: