Healthcare Provider Details

I. General information

NPI: 1124155940
Provider Name (Legal Business Name): EMMAUS INSTITUTE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 BROAD ST STE 1538
NASHUA NH
03063-3205
US

IV. Provider business mailing address

154 BROAD ST STE 1538
NASHUA NH
03063-3205
US

V. Phone/Fax

Practice location:
  • Phone: 603-886-3760
  • Fax: 603-821-6142
Mailing address:
  • Phone: 603-886-3760
  • Fax: 603-821-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MANSEAU
Title or Position: DIRECTOR
Credential: D.MIN.
Phone: 603-886-3760