Provider Demographics
NPI:1609482389
Name:GOGLIN, KURT E (LPC)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:E
Last Name:GOGLIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W TIOGA ST
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-1496
Mailing Address - Country:US
Mailing Address - Phone:570-836-2795
Mailing Address - Fax:570-836-7103
Practice Address - Street 1:133 W TIOGA ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1496
Practice Address - Country:US
Practice Address - Phone:570-836-2795
Practice Address - Fax:570-836-7103
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS012660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicaid