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General NPI Number Information
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NPI Number | 1932808953
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Entity Type | Organization
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Legal Business Name | EBBTIDE BEHAVIORAL HEALTH ASSOCIATES PLLC
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 83 LAFAYETTE RD UNIT 47-B
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City | HAMPTON FALLS
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State | NH
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Zip | 03844-2303
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Country | US
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Telephone | 802-793-9177
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Fax |
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Provider Business Mailing Address
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Address Line | 83 LAFAYETTE RD UNIT 47-B
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City | HAMPTON FALLS
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State | NH
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Zip | 03844-2303
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Country | US
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Telephone | 802-793-9177
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | TASHA L HUMPHREYS
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Credential | APRN
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Telephone | 802-793-9177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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