Healthcare Provider Details

I. General information

NPI: 1245339241
Provider Name (Legal Business Name): LARRY JOE PUGEL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E STATE ST
ALBION PA
16401-1348
US

IV. Provider business mailing address

4345 N BEND RD
ASHTABULA OH
44004-9797
US

V. Phone/Fax

Practice location:
  • Phone: 814-935-4074
  • Fax: 440-536-4115
Mailing address:
  • Phone: 814-935-4074
  • Fax: 814-935-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00004396
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1526
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004967
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: