Healthcare Provider Details

I. General information

NPI: 1801620562
Provider Name (Legal Business Name): PLOTT BALSAM MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 MAIN ST
ST JOHNSBURY VT
05819-2601
US

IV. Provider business mailing address

1129 MAIN ST
ST JOHNSBURY VT
05819-2601
US

V. Phone/Fax

Practice location:
  • Phone: 828-506-9979
  • Fax: 828-787-8183
Mailing address:
  • Phone: 828-506-9979
  • Fax: 828-787-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW C KIRBY
Title or Position: OWNER/THERAPIST
Credential: LCMHC
Phone: 828-506-9979