Provider Demographics
NPI:1013679422
Name:FORRESTALL COUNSELING LLC
Entity Type:Organization
Organization Name:FORRESTALL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FORRESTALL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-668-0255
Mailing Address - Street 1:288 ROUTE 101 STE 101
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5152
Mailing Address - Country:US
Mailing Address - Phone:603-668-0255
Mailing Address - Fax:
Practice Address - Street 1:288 ROUTE 101 STE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5152
Practice Address - Country:US
Practice Address - Phone:603-668-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)