Healthcare Provider Details

I. General information

NPI: 1902029812
Provider Name (Legal Business Name): ELIZABETH STREETT LICHT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 LIBERTY HILL RD BLDG 2 SUITE 218
HENNIKER NH
03242-6045
US

IV. Provider business mailing address

PO BOX 529
HENNIKER NH
03242-0529
US

V. Phone/Fax

Practice location:
  • Phone: 603-428-7400
  • Fax:
Mailing address:
  • Phone: 603-428-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number760
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: