=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962088435
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESA MARIE MURGOLA LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2021
-----------------------------------------------------
Last Update Date | 08/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 MILFORD DR STE 218
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44236-2779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-650-4423
-----------------------------------------------------
Fax | 330-655-4329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 MILFORD DR STE 218
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44236-2779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-650-4423
-----------------------------------------------------
Fax | 330-655-4329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | C.2204001
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E.2404547
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------