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General NPI Number Information
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NPI Number | 1700334281
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Entity Type | Organization
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Legal Business Name | LEGOULLON COUNSELING SERVICES
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 1243 LIBERTY ST SUITE 312
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City | FRANKLIN
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State | PA
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Zip | 16323-1326
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Country | US
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Telephone | 814-657-2067
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Fax |
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Provider Business Mailing Address
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Address Line | 1243 LIBERTY ST SUITE 312
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City | FRANKLIN
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State | PA
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Zip | 16323-1326
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Country | US
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Telephone | 814-657-2067
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE ANNE LEGOULLON
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Credential | LCSW
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Telephone | 814-657-2067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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