MEDICARE: EULALIA BOARD LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	E.2606470	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033634035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EULALIA BOARD LPC

Provider Business Mailing Address
First Line	:	3437 MAPLE DR
Second Line	:
City	:	NEW WATERFORD
State	:	OH
Zip	:	44445-9602
Country	:	US
Telephone Number	:	330-619-6970
Fax Number	:

Provider Business Practice Location Address
First Line	:	8170 SOUTH AVENUE
Second Line	:	SUITE 7
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6434
Country	:	US
Telephone Number	:	330-953-3325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2017
Last Update Date	:	04/02/2026

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Directions to “ EULALIA BOARD LPC” Practice Location

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