Provider Demographics
NPI:1316388788
Name:SEBAGO LAKE COUNSELING & CONSULTATION PA
Entity type:Organization
Organization Name:SEBAGO LAKE COUNSELING & CONSULTATION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MARTEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-233-1332
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084
Mailing Address - Country:US
Mailing Address - Phone:207-233-1332
Mailing Address - Fax:207-642-2314
Practice Address - Street 1:70 OSSIPEE TRL E
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6400
Practice Address - Country:US
Practice Address - Phone:207-233-1332
Practice Address - Fax:207-642-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3876251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health