Provider Demographics
NPI:1598002719
Name:PAGLEN, PETER (MA, NCC, LCMHC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:PAGLEN
Suffix:
Gender:M
Credentials:MA, NCC, 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 1614
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-1614
Mailing Address - Country:US
Mailing Address - Phone:828-333-4170
Mailing Address - Fax:
Practice Address - Street 1:8562 NC HIGHWAY 105 S UNIT 102
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7879
Practice Address - Country:US
Practice Address - Phone:828-333-4170
Practice Address - Fax:855-404-4030
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional