Healthcare Provider Details

I. General information

NPI: 1376851675
Provider Name (Legal Business Name): ANDREW E. SEGUEL MS, LPC, LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 PINNACLE RDG
UNDERHILL VT
05489-4411
US

IV. Provider business mailing address

22 PINNACLE RDG
UNDERHILL VT
05489-4411
US

V. Phone/Fax

Practice location:
  • Phone: 318-523-0523
  • Fax:
Mailing address:
  • Phone: 973-980-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00611600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number068.0134602
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134602
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00611600
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number068.0134602
License Number StateVT
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00611600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: