Healthcare Provider Details

I. General information

NPI: 1497269740
Provider Name (Legal Business Name): PERINATAL AND WOMEN'S MENTAL HEALTH COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2017
Last Update Date: 11/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 ENTERPRISE DR
WINDHAM NH
03087-2032
US

IV. Provider business mailing address

24 SIMPSON RD
WINDHAM NH
03087-2216
US

V. Phone/Fax

Practice location:
  • Phone: 603-233-4963
  • Fax:
Mailing address:
  • Phone: 603-233-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number771
License Number StateNH

VII. Legacy identifiers

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

# 1
Identifier3071993
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name: AMY CHOUINARD
Title or Position: OWNER
Credential: LCMHC
Phone: 603-233-4092