MEDICARE: DR. LARRY JOE PUGEL PHD

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	101YM0800X	Mental Health Counselor	LH00004396	WA
2	101YP2500X	Professional Counselor	1526	CO
3	101YP2500X	Professional Counselor	PC004967	PA

General Provider Information

NPI Number	:	1245339241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY JOE PUGEL PHD

Provider Business Mailing Address
First Line	:	4345 N BEND RD
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-9797
Country	:	US
Telephone Number	:	814-935-4074
Fax Number	:	814-935-4074

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/06/2020

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