Healthcare Provider Details

I. General information

NPI: 1043647308
Provider Name (Legal Business Name): HEATHER GAYLORD MS, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PLEASANT ST
CONCORD NH
03301-4006
US

IV. Provider business mailing address

PO BOX 2032
CONCORD NH
03302-2032
US

V. Phone/Fax

Practice location:
  • Phone: 844-743-5748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2072
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: