Healthcare Provider Details

I. General information

NPI: 1588438683
Provider Name (Legal Business Name): CHARLES L HUERTH LCPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

IV. Provider business mailing address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

V. Phone/Fax

Practice location:
  • Phone: 888-322-2136
  • Fax:
Mailing address:
  • Phone: 888-322-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL7241
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: