=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134293426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRUCE ALEXANDER MAGOON LCMHC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 370 MAIN ST
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-526-4230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 361 SCHOODAC RD
-----------------------------------------------------
City | WARNER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03278-4618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-456-2486
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 489
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------