MEDICARE: LARRY J PUGEL, PH.D., 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

General Provider Information

NPI Number	:	1073222816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY J PUGEL, PH.D., LPC

Provider Business Mailing Address
First Line	:	4345 N BEND RD
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-9797
Country	:	US
Telephone Number	:	303-517-8084
Fax Number	:	440-536-4115

Provider Business Practice Location Address
First Line	:	131 E STATE ST
Second Line	:
City	:	ALBION
State	:	PA
Zip	:	16401-1348
Country	:	US
Telephone Number	:	814-935-4074
Fax Number	:	440-536-4115

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RUTH ELAINE PUGEL
Credential	:
Telephone Number	:	303-517-8084

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	11/21/2022

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