=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396396230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURSUING HOPE COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2019
-----------------------------------------------------
Last Update Date | 09/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 HARTFORD TPKE
-----------------------------------------------------
City | VERNON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06066-5245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-967-4627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 MANSE HILL RD
-----------------------------------------------------
City | SOMERS
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06071-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-967-4627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | NICOLLE ELIZABETH WARGO
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 860-967-4627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------