=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760018964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEAH F PUGH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2020
-----------------------------------------------------
Last Update Date | 03/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 243 E MAIN ST
-----------------------------------------------------
City | MOREHEAD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40351-1691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-291-8743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 243 E MAIN ST
-----------------------------------------------------
City | MOREHEAD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40351-1691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-291-8743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEAH F PUGH
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 606-291-8743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------