Provider Demographics
NPI:1710437066
Name:MOUNTAIN WELLNESS ASSOCIATES
Entity Type:Organization
Organization Name:MOUNTAIN WELLNESS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:603-283-0195
Mailing Address - Street 1:MOUNTAIN WELLNESS ASSOCIATES
Mailing Address - Street 2:163 WASHINGTON STREET
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3131
Mailing Address - Country:US
Mailing Address - Phone:603-283-0195
Mailing Address - Fax:603-283-0197
Practice Address - Street 1:MOUNTAIN WELLNESS ASSOCIATES
Practice Address - Street 2:163 WASHINGTON STREET
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3131
Practice Address - Country:US
Practice Address - Phone:603-283-0195
Practice Address - Fax:603-283-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1215103T00000X
NH1399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3106376Medicaid