Healthcare Provider Details

I. General information

NPI: 1477189744
Provider Name (Legal Business Name): COUNSELING SERVICES OF KEENE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WASHINGTON ST
KEENE NH
03431-3131
US

IV. Provider business mailing address

94 HILL RD
ALSTEAD NH
03602-3213
US

V. Phone/Fax

Practice location:
  • Phone: 401-644-6538
  • Fax:
Mailing address:
  • Phone: 401-644-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ASHLEIGH MONDOUX
Title or Position: SOLE MEMBER
Credential: LICSW
Phone: 401-644-6538