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General NPI Number Information
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NPI Number | 1154284370
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Entity Type | Organization
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Legal Business Name | NORTHERN LIGHTS PSYCHIATRY SERVICE LLP
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 15 CONSTITUTION DR
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City | BEDFORD
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State | NH
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Zip | 03110-6042
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Country | US
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Telephone | 603-718-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 15 CONSTITUTION DR OFC 113
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City | BEDFORD
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State | NH
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Zip | 03110-6042
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Country | US
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Telephone | 603-718-3939
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Fax |
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Authorized Official
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Title or Position | APRN OWNER
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Name | ANGELA LEIGH PETERS
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Credential | APRN
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Telephone | 603-718-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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