Provider Demographics
NPI:1508410440
Name:MIDDLE PATH COUNSELING, LLC
Entity Type:Organization
Organization Name:MIDDLE PATH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLLNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:978-254-1135
Mailing Address - Street 1:12 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2950
Mailing Address - Country:US
Mailing Address - Phone:978-254-1135
Mailing Address - Fax:
Practice Address - Street 1:12 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2950
Practice Address - Country:US
Practice Address - Phone:978-254-1135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3101123Medicaid