Provider Demographics
NPI:1619593563
Name:JOAN BREAULT COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:JOAN BREAULT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAULT
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:603-874-4440
Mailing Address - Street 1:2 WASHINGTON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-5023
Mailing Address - Country:US
Mailing Address - Phone:603-874-4440
Mailing Address - Fax:
Practice Address - Street 1:2 WASHINGTON ST STE 301
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5023
Practice Address - Country:US
Practice Address - Phone:603-874-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1245864156OtherNPI