1578741674 NPI number — MS. ERIN LEA GOEDEGEBUURE MA, LPC

Table of content: MS. ERIN LEA GOEDEGEBUURE MA, LPC (NPI 1578741674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578741674 NPI number — MS. ERIN LEA GOEDEGEBUURE MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOEDEGEBUURE
Provider First Name:
ERIN
Provider Middle Name:
LEA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578741674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 373
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17827-0373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-765-1051
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1372 N SUSQUEHANNA TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELINSGROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17870-8971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-2323
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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