MEDICARE: FAMILY TREE GUIDANCE SERVICES, 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	1041C0700X	Clinical Social Worker	1241	NH
2	101YM0800X	Mental Health Counselor	676	NH

General Provider Information

NPI Number	:	1972754430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY TREE GUIDANCE SERVICES, LLC

Provider Business Mailing Address
First Line	:	370 PORTSMOUTH AVE UNIT 207
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-2252
Country	:	US
Telephone Number	:	603-435-3323
Fax Number	:	866-567-6780

Provider Business Practice Location Address
First Line	:	370 PORTSMOUTH AVE UNIT 207
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-2252
Country	:	US
Telephone Number	:	603-435-3323
Fax Number	:	866-567-6780

Authorized Official
Title or Position	:	MANAGER
Name	:	LINDSAY JOE
Credential	:	LCMHC
Telephone Number	:	603-479-5282

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	10/02/2008

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