Healthcare Provider Details

I. General information

NPI: 1447154869
Provider Name (Legal Business Name): MISSISQUOI MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MAIN ST
ENOSBURG FALLS VT
05450-5001
US

IV. Provider business mailing address

PO BOX 80
ENOSBURG FALLS VT
05450-0080
US

V. Phone/Fax

Practice location:
  • Phone: 802-309-2044
  • Fax:
Mailing address:
  • Phone: 802-309-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN-PAUL M CLOUTIER
Title or Position: MANAGING MEMBER
Credential: PMHNP-BC
Phone: 802-309-2044