Provider Demographics
NPI:1689869406
Name:THE MILLYARD HEALTH COLLABORATIVE
Entity Type:Organization
Organization Name:THE MILLYARD HEALTH COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:603-767-7144
Mailing Address - Street 1:26 MILLYARD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2429
Mailing Address - Country:US
Mailing Address - Phone:603-767-7144
Mailing Address - Fax:
Practice Address - Street 1:26 MILLYARD
Practice Address - Street 2:SUITE 7
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2429
Practice Address - Country:US
Practice Address - Phone:603-767-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5980101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1247OtherBLUE CROSS BLUE SHIELD