Healthcare Provider Details

I. General information

NPI: 1225226640
Provider Name (Legal Business Name): B G L AND ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N COURT ST SUITE 2
MEDINA OH
44256-1934
US

IV. Provider business mailing address

107 N COURT ST SUITE 2
MEDINA OH
44256-1934
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-9000
  • Fax:
Mailing address:
  • Phone: 330-722-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0007664
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF0500030
License Number StateOH

VIII. Authorized Official

Name: MR. BERNARD G LABBE
Title or Position: PRESIDENT
Credential: PCC, IMFT
Phone: 330-722-9000