Healthcare Provider Details

I. General information

NPI: 1639861107
Provider Name (Legal Business Name): FOUR PEAKS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 MAIN ST STE 201
WATERVILLE ME
04901-6602
US

IV. Provider business mailing address

47 WINTER ST
WATERVILLE ME
04901-7336
US

V. Phone/Fax

Practice location:
  • Phone: 207-902-8767
  • Fax:
Mailing address:
  • Phone: 207-390-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRIAN MCARTHUR
Title or Position: COUNSELOR
Credential: LCPC-CONDITIONAL
Phone: 207-390-1975