Provider Demographics
NPI:1508339714
Name:SKOGLUND, ELIZABETH RENEHAN (LCMHC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RENEHAN
Last Name:SKOGLUND
Suffix:
Gender:F
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:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05251-0561
Mailing Address - Country:US
Mailing Address - Phone:802-949-0726
Mailing Address - Fax:
Practice Address - Street 1:4697 MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-8945
Practice Address - Country:US
Practice Address - Phone:802-949-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3483101Y00000X
VT068.0134405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor