Olivia Egan Counseling Services, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

LPC007842 Issued in GA

Legal business name

OLIVIA EGAN COUNSELING SERVICES, LLC

Practice address

311 Mobley Dr
Statesboro, GA 30458-9162

Phone

(678) 837-5465

NPI assigned

Aug 23, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Olivia Egan, LPC

Title

Sole Member

Phone

(678) 837-5465

Specialties & licenses 4

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503446400000",
    "number": "1659898401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 MOBLEY DR",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304589162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 MOBLEY DR",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304589162",
            "telephone_number": "678-837-5465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVIA EGAN COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-23",
        "last_updated": "2017-08-23",
        "status": "A",
        "authorized_official_last_name": "EGAN",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "678-837-5465",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "GA",
            "license": "LPC007842",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "LPC007842",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "GA",
            "license": "LPC007842",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.