Provider Demographics
NPI:1740259555
Name:AXTMAN, RICK M (MA LCMHC)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:M
Last Name:AXTMAN
Suffix:
Gender:M
Credentials:MA LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BICENTENNIAL SQUARE
Mailing Address - Street 2:BSCA 2ND FLOOR
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:603-226-1979
Practice Address - Street 1:4 BICENTENNIAL SQUARE
Practice Address - Street 2:BSCA 2ND FLOOR
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-226-1976
Practice Address - Fax:603-226-1979
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH169101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422449Medicaid