MEDICARE: LAURA MOGDEN COUNSELING SERVICES LLC

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

General Provider Information

NPI Number	:	1053888149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA MOGDEN COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	632 PEONY DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81507-1002
Country	:	US
Telephone Number	:	970-903-2521
Fax Number	:

Provider Business Practice Location Address
First Line	:	546 MAIN ST STE 403
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2683
Country	:	US
Telephone Number	:	970-596-8968
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA A MOGDEN
Credential	:	MA
Telephone Number	:	970-903-2521

Provider Enumeration Date	:	10/27/2018
Last Update Date	:	10/27/2018

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