Healthcare Provider Details

I. General information

NPI: 1760625602
Provider Name (Legal Business Name): TAIGHSOLAIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CORDAGE PARK SUITE 123
PLYMOUTH MA
02360
US

IV. Provider business mailing address

30 JACQUELINE LN
PLYMOUTH MA
02360-4672
US

V. Phone/Fax

Practice location:
  • Phone: 508-927-6920
  • Fax:
Mailing address:
  • Phone: 508-927-6920
  • Fax: 508-689-7695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6313
License Number StateMA

VIII. Authorized Official

Name: MR. WILLIAM CLIFFORD HAUGHN
Title or Position: OWNER
Credential: LMHC
Phone: 508-927-6920