=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447553631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA RHYS LCMHC MLADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2010
-----------------------------------------------------
Last Update Date | 07/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 COMMERCE PARK N STE 13B
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-6959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-606-1233
-----------------------------------------------------
Fax | 603-606-1233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 COMMERCE PARK N STE 13B
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-6959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-606-1233
-----------------------------------------------------
Fax | 603-606-1233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 0848
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1147
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------