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General NPI Number Information
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NPI Number | 1225216625
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Entity Type | Organization
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Legal Business Name | MAIN STREET MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 11 CANAL ST
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City | MEREDITH
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State | NH
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Zip | 03253-5902
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Country | US
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Telephone | 603-738-2445
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 535
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City | MEREDITH
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State | NH
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Zip | 03253-0535
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Country | US
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Telephone | 603-738-2445
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Fax | 603-279-7042
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Authorized Official
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Title or Position | OWNER
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Name | MS. JOAN ST JEAN
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Credential | APRN
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Telephone | 603-738-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 026459-23-08
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License Number State | NH
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