=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538853346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITE MOUNTAIN EXPRESSIVE ARTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2023
-----------------------------------------------------
Last Update Date | 06/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 HIGH ST.
-----------------------------------------------------
City | BETHEL
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-808-0373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7363
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98507-7363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-808-0373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOY CROMWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-808-0373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------