Provider Demographics
NPI:1417719931
Name:JUDY GAGNON COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:JUDY GAGNON COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:207-698-0475
Mailing Address - Street 1:64 MERCHANTS ROW
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:ME
Mailing Address - Zip Code:04027-4305
Mailing Address - Country:US
Mailing Address - Phone:207-698-0475
Mailing Address - Fax:207-850-1063
Practice Address - Street 1:469 MAIN ST STE 308
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1872
Practice Address - Country:US
Practice Address - Phone:207-698-0475
Practice Address - Fax:207-850-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)