MEDICARE: MR. BRIAN KEITH ALTENBACH LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5658	NH
2	101YP2500X	Professional Counselor	PC003926	PA

General Provider Information

NPI Number	:	1356515902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN KEITH ALTENBACH LCMHC

Provider Business Mailing Address
First Line	:	PO BOX 675125
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-5125
Country	:	US
Telephone Number	:	603-883-0005
Fax Number	:	603-883-0007

Provider Business Practice Location Address
First Line	:	5 CHENELL DR STE 110
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-8503
Country	:	US
Telephone Number	:	603-883-0005
Fax Number	:	603-883-0007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	03/11/2026

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