=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609330604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 603 COUNSELING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2019
-----------------------------------------------------
Last Update Date | 01/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 BIRCH ST STE 205
-----------------------------------------------------
City | DERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03038-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-892-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 BIRCH ST STE 205
-----------------------------------------------------
City | DERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03038-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-892-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RODNEY BAKER
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 603-892-9777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------