Provider Demographics
NPI:1700648425
Name:VERMONT MENTAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:VERMONT MENTAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-881-2452
Mailing Address - Street 1:1735 QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:VT
Mailing Address - Zip Code:05443-9276
Mailing Address - Country:US
Mailing Address - Phone:802-881-2452
Mailing Address - Fax:
Practice Address - Street 1:135 ALLEN BROOK LN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9201
Practice Address - Country:US
Practice Address - Phone:802-881-2452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty