Healthcare Provider Details

I. General information

NPI: 1316685662
Provider Name (Legal Business Name): BISON COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 S MAIN ST STE 104
MANCHESTER NH
03102-5141
US

IV. Provider business mailing address

765 S MAIN ST STE 104
MANCHESTER NH
03102-5141
US

V. Phone/Fax

Practice location:
  • Phone: 603-696-6314
  • Fax: 603-825-7712
Mailing address:
  • Phone: 603-696-6314
  • Fax: 603-825-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA FITZPATRICK
Title or Position: OWNER
Credential: MSW
Phone: 603-696-6314