Provider Demographics
NPI:1568188662
Name:MILL BROOK WELLNESS, PLLC
Entity Type:Organization
Organization Name:MILL BROOK WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-243-0215
Mailing Address - Street 1:448 DANA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH POMFRET
Mailing Address - State:VT
Mailing Address - Zip Code:05053-5052
Mailing Address - Country:US
Mailing Address - Phone:781-799-2611
Mailing Address - Fax:
Practice Address - Street 1:20 W PARK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1378
Practice Address - Country:US
Practice Address - Phone:802-243-0215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)