Provider Demographics
NPI:1073222816
Name:LARRY J PUGEL, PH.D., LPC
Entity Type:Organization
Organization Name:LARRY J PUGEL, PH.D., LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PUGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-517-8084
Mailing Address - Street 1:4345 N BEND RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9797
Mailing Address - Country:US
Mailing Address - Phone:303-517-8084
Mailing Address - Fax:440-536-4115
Practice Address - Street 1:131 E STATE ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:PA
Practice Address - Zip Code:16401-1348
Practice Address - Country:US
Practice Address - Phone:814-935-4074
Practice Address - Fax:440-536-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty