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General NPI Number Information
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NPI Number | 1528622909
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Entity Type | Organization
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Legal Business Name | OLDE PORT COUNSELING, PLLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 406 THE HL
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City | PORTSMOUTH
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State | NH
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Zip | 03801-3736
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Country | US
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Telephone | 978-432-9560
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Fax |
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Provider Business Mailing Address
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Address Line | 406 THE HL
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City | PORTSMOUTH
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State | NH
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Zip | 03801-3736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. MATTHEW FOWLER
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Credential | LMFT
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Telephone | 603-531-8811
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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