Provider Demographics
NPI:1629484654
Name:COCHECO FALLS COUNSELING, LLC
Entity Type:Organization
Organization Name:COCHECO FALLS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCMHC
Authorized Official - Phone:603-343-4678
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:SUITE 143
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3882
Mailing Address - Country:US
Mailing Address - Phone:603-343-4678
Mailing Address - Fax:603-343-5324
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:SUITE 143
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3882
Practice Address - Country:US
Practice Address - Phone:603-343-4678
Practice Address - Fax:603-343-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH924261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)