Provider Demographics
NPI:1093194474
Name:KERRY E. HOAG PSYD
Entity Type:Organization
Organization Name:KERRY E. HOAG PSYD
Other - Org Name:LIGHTHOUSE COUNSELING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOAG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-361-3036
Mailing Address - Street 1:266 YORK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1050
Mailing Address - Country:US
Mailing Address - Phone:207-361-3036
Mailing Address - Fax:
Practice Address - Street 1:266 YORK ST STE 3
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1050
Practice Address - Country:US
Practice Address - Phone:207-361-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1206103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty