Provider Demographics
NPI:1457980559
Name:MATTISON, LORI (LCMHC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MATTISON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1235
Mailing Address - Country:US
Mailing Address - Phone:603-626-9500
Mailing Address - Fax:603-935-5392
Practice Address - Street 1:145 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1235
Practice Address - Country:US
Practice Address - Phone:603-626-9500
Practice Address - Fax:603-935-5392
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health