Provider Demographics
NPI:1861815094
Name:ENDURANCE BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:ENDURANCE BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:603-918-4222
Mailing Address - Street 1:867 LAFAYETTE RD
Mailing Address - Street 2:P.O. BOX 2899
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-4217
Mailing Address - Country:US
Mailing Address - Phone:603-918-4222
Mailing Address - Fax:603-760-1949
Practice Address - Street 1:823 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4215
Practice Address - Country:US
Practice Address - Phone:603-760-1942
Practice Address - Fax:603-760-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1292103TC2200X
MA314057104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty