=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780410001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING PATH HOLISTIC PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2024
-----------------------------------------------------
Last Update Date | 09/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 RAILROAD SQ STE 1
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-6139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-204-3671
-----------------------------------------------------
Fax | 207-607-7816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 RAILROAD SQ STE 1
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-6139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-204-3671
-----------------------------------------------------
Fax | 207-607-7816
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. MICHELLE BRETON
-----------------------------------------------------
Credential | EDD, PMHNP-BC
-----------------------------------------------------
Telephone | 207-204-3671
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------