Provider Demographics
NPI:1497512198
Name:FUSION BEHAVIORAL CARE, LLC
Entity Type:Organization
Organization Name:FUSION BEHAVIORAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THERIAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-440-8618
Mailing Address - Street 1:280 PLEASANT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2553
Mailing Address - Country:US
Mailing Address - Phone:603-622-8665
Mailing Address - Fax:833-413-4978
Practice Address - Street 1:280 PLEASANT ST STE 1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2553
Practice Address - Country:US
Practice Address - Phone:603-622-8665
Practice Address - Fax:833-413-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health