Provider Demographics
NPI:1477189744
Name:COUNSELING SERVICES OF KEENE PLLC
Entity Type:Organization
Organization Name:COUNSELING SERVICES OF KEENE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDOUX
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-644-6538
Mailing Address - Street 1:94 HILL RD
Mailing Address - Street 2:
Mailing Address - City:ALSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03602-3213
Mailing Address - Country:US
Mailing Address - Phone:401-644-6538
Mailing Address - Fax:
Practice Address - Street 1:155 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3131
Practice Address - Country:US
Practice Address - Phone:401-644-6538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health