Healthcare Provider Details

I. General information

NPI: 1710437066
Provider Name (Legal Business Name): MOUNTAIN WELLNESS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOUNTAIN WELLNESS ASSOCIATES 163 WASHINGTON STREET
KEENE NH
03431-3131
US

IV. Provider business mailing address

MOUNTAIN WELLNESS ASSOCIATES 163 WASHINGTON STREET
KEENE NH
03431-3131
US

V. Phone/Fax

Practice location:
  • Phone: 603-283-0195
  • Fax: 603-283-0197
Mailing address:
  • Phone: 603-283-0195
  • Fax: 603-283-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1399
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1215
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3106376
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name: DR. MEGHAN ESTEY
Title or Position: CEO & PSYCHOLOGIST
Credential: PSY.D
Phone: 603-283-0195