MEDICARE: ADVENTURELORE LLC

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	1245	NH

General Provider Information

NPI Number	:	1457876054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENTURELORE LLC

Provider Business Mailing Address
First Line	:	197 LONG POND RD
Second Line	:
City	:	DANVILLE
State	:	NH
Zip	:	03819-3127
Country	:	US
Telephone Number	:	603-382-4661
Fax Number	:	603-382-0571

Provider Business Practice Location Address
First Line	:	197 LONG POND RD
Second Line	:
City	:	DANVILLE
State	:	NH
Zip	:	03819-3127
Country	:	US
Telephone Number	:	603-382-4661
Fax Number	:	603-382-0571

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RYAN E. HOLDER
Credential	:	M.ED, LMHC
Telephone Number	:	603-382-4661

Provider Enumeration Date	:	08/04/2017
Last Update Date	:	07/21/2022

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