Provider Demographics
NPI:1417333444
Name:GLENN DUMONT
Entity Type:Organization
Organization Name:GLENN DUMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:603-504-6188
Mailing Address - Street 1:24 OPERA HOUSE SQ
Mailing Address - Street 2:SUITE 406, BOX 11
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-5408
Mailing Address - Country:US
Mailing Address - Phone:603-504-6188
Mailing Address - Fax:
Practice Address - Street 1:24 OPERA HOUSE SQ
Practice Address - Street 2:SUITE 406, BOX 11
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-5408
Practice Address - Country:US
Practice Address - Phone:603-504-6188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1098251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health