Healthcare Provider Details

I. General information

NPI: 1295341931
Provider Name (Legal Business Name): EMILY PICHLER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PINE HAVEN SHORES RD STE 1000
SHELBURNE VT
05482-7812
US

IV. Provider business mailing address

145 PINE HAVEN SHORES RD STE 1000
SHELBURNE VT
05482-7812
US

V. Phone/Fax

Practice location:
  • Phone: 802-448-2243
  • Fax:
Mailing address:
  • Phone: 802-448-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. EMILY PICHLER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 802-448-2243