Healthcare Provider Details

I. General information

NPI: 1972754430
Provider Name (Legal Business Name): FAMILY TREE GUIDANCE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 PORTSMOUTH AVE UNIT 207
GREENLAND NH
03840-2252
US

IV. Provider business mailing address

370 PORTSMOUTH AVE UNIT 207
GREENLAND NH
03840-2252
US

V. Phone/Fax

Practice location:
  • Phone: 603-435-3323
  • Fax: 866-567-6780
Mailing address:
  • Phone: 603-435-3323
  • Fax: 866-567-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number676
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1241
License Number StateNH

VIII. Authorized Official

Name: LINDSAY JOE
Title or Position: MANAGER
Credential: LCMHC
Phone: 603-479-5282