Provider Demographics
NPI:1689021800
Name:SHELLEY CUSHNER GARDNER COUNSELING PLLC
Entity Type:Organization
Organization Name:SHELLEY CUSHNER GARDNER COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:CUSHNER
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:603-339-1012
Mailing Address - Street 1:20 MARY E CLARK DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-2292
Mailing Address - Country:US
Mailing Address - Phone:603-339-1012
Mailing Address - Fax:
Practice Address - Street 1:20 MARY E CLARK DR
Practice Address - Street 2:SUITE 8
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2292
Practice Address - Country:US
Practice Address - Phone:603-339-1012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH93251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1962527044OtherINDIVIDUAL NPI