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General NPI Number Information
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NPI Number | 1215749072
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Entity Type | Organization
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Legal Business Name | BENEATH THE BOUGHS, PLLC
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 67 EASTERN AVE STE 306
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-5642
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Country | US
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Telephone | 802-535-4734
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Fax |
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Provider Business Mailing Address
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Address Line | 279 OLD CONCORD RD
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-8983
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Country | US
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Telephone | 802-535-4734
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARGARET BEADLE
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Credential | LCMHC
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Telephone | 802-535-4734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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