Healthcare Provider Details

I. General information

NPI: 1073382743
Provider Name (Legal Business Name): LAURA MCDONOUGH CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MARMION AVE
YOUNGSTOWN OH
44502-2323
US

IV. Provider business mailing address

1960 E COUNTY LINE RD STE 5
MINERAL RIDGE OH
44440-9451
US

V. Phone/Fax

Practice location:
  • Phone: 330-782-5664
  • Fax: 330-782-1614
Mailing address:
  • Phone: 330-531-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2305275-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: