Provider Demographics
NPI:1679939938
Name:FALGOUT, JEREMY JAMES (LPC,NCC)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:JAMES
Last Name:FALGOUT
Suffix:
Gender:M
Credentials:LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 TWIN PONDS RD
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1843
Mailing Address - Country:US
Mailing Address - Phone:484-373-9309
Mailing Address - Fax:
Practice Address - Street 1:628 TWIN PONDS RD
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1843
Practice Address - Country:US
Practice Address - Phone:484-373-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-01
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PAPC011729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor