=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134333131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWN JASON HASSELL M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 CHESTNUT ST SUITE 103
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03101-1447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-223-4062
-----------------------------------------------------
Fax | 603-641-3499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 153 OLD HEDDING RD UNIT 13
-----------------------------------------------------
City | EPPING
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03042-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-679-8024
-----------------------------------------------------
Fax | 603-641-3499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 69
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------