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General NPI Number Information
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NPI Number | 1861664922
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Entity Type | Organization
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Legal Business Name | KMR COUNSELING, INC
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Dates
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Enumeration Date | 03/29/2008
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 1008 LISBON ST
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City | LEWISTON
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State | ME
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Zip | 04240-5721
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Country | US
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Telephone | 207-784-1480
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Fax | 207-753-0323
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Provider Business Mailing Address
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Address Line | 1008 LISBON ST
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City | LEWISTON
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State | ME
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Zip | 04240-5721
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Country | US
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Telephone | 207-784-1480
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Fax | 207-753-0323
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | MRS. MURIELLE M. GUAY
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Credential | LCSW
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Telephone | 207-784-1480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC10066
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License Number State | ME
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