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NPI Code Detail

MEDICARE: KEITH S TRUDEL LADC

MEDICARE: KEITH S TRUDEL LADC
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
1101Y00000XCounselorCAC6403ME
2101Y00000XCounselorLC6841ME

General Provider Information

NPI Number : 1548776388
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH S TRUDEL LADC
Provider Business Mailing Address
First Line : 180 ACADEMY ST STE 3
Second Line :
City : PRESQUE ISLE
State : ME
Zip : 04769-3183
Country : US
Telephone Number : 207-554-2352
Fax Number : 207-554-2351
Provider Business Practice Location Address
First Line : 382 MAIN ST
Second Line :
City : LIMESTONE
State : ME
Zip : 04750-6607
Country : US
Telephone Number : 207-498-6431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2017
Last Update Date : 02/02/2021

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Directions to “ KEITH S TRUDEL LADC” Practice Location

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