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General NPI Number Information
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NPI Number | 1740650019
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Entity Type | Organization
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Legal Business Name | SPACE TO BREATHE, PLLC
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 105 WEST MAIN STREET SUITE 3
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City | LITTLETON
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State | NH
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Zip | 03561
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Country | US
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Telephone | 603-631-4528
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Fax | 888-822-8323
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Provider Business Mailing Address
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Address Line | 105 WEST MAIN STREET SUITE 3
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City | LITTLETON
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State | NH
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Zip | 03561
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Country | US
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Telephone | 603-631-4528
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Fax | 888-822-8323
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. KELLY MCCANN
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Credential | PH.D.
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Telephone | 603-631-4528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1251
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License Number State | NH
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