Healthcare Provider Details

I. General information

NPI: 1598677361
Provider Name (Legal Business Name): SEASONS PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E MAIN ST
YARMOUTH ME
04096-6909
US

IV. Provider business mailing address

224 E MAIN ST
YARMOUTH ME
04096-6909
US

V. Phone/Fax

Practice location:
  • Phone: 872-222-7387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHANNON PEDERSEN
Title or Position: PSYCHOTHERAPIST
Credential:
Phone: 815-451-6313