Healthcare Provider Details

I. General information

NPI: 1225341316
Provider Name (Legal Business Name): PAINTED HORSES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 09/26/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MCLAIN ROAD
LIBERTY ME
04949-3715
US

IV. Provider business mailing address

95 MCLAIN ROAD
LIBERTY ME
04949-3715
US

V. Phone/Fax

Practice location:
  • Phone: 207-837-7671
  • Fax: 207-737-7137
Mailing address:
  • Phone: 207-837-7671
  • Fax: 207-737-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC8501
License Number StateME

VIII. Authorized Official

Name: APRIL CLOUTIER
Title or Position: SOLE PROPRIETOR
Credential: LCSW
Phone: 207-837-7671