=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427862291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURA TENNENHOUSE PSYCHOTHERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2025
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 187 SUMMIT ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-2925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-209-3828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 439 US ROUTE 1 STE A
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 03909-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-209-3828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | LAURA TENNENHOUSE
-----------------------------------------------------
Credential | CLCPC
-----------------------------------------------------
Telephone | 207-209-3828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------