Provider Demographics
NPI:1134293426
Name:MAGOON, BRUCE ALEXANDER (LCMHC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALEXANDER
Last Name:MAGOON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 SCHOODAC RD
Mailing Address - Street 2:
Mailing Address - City:WARNER
Mailing Address - State:NH
Mailing Address - Zip Code:03278-4618
Mailing Address - Country:US
Mailing Address - Phone:603-456-2486
Mailing Address - Fax:
Practice Address - Street 1:370 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03256
Practice Address - Country:US
Practice Address - Phone:603-526-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health