1912980517 NPI number — MS. JAMIE MITCHELL HALLENGREN M.A., L.M.F.T

Table of content: (NPI 1346909173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912980517 NPI number — MS. JAMIE MITCHELL HALLENGREN M.A., L.M.F.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALLENGREN
Provider First Name:
JAMIE
Provider Middle Name:
MITCHELL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.M.F.T
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912980517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 PINE TREE CIR
Provider Second Line Business Mailing Address:
PO BOX 485
Provider Business Mailing Address City Name:
SPOFFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03462-4005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-363-8481
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 ROXBURY ST
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-8801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-355-6655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  76 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30423474 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9384420 . This is a "PHCS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 311262 . This is a "MHN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 5483118 . This is a "ULTRABENEFITS/HCVM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 14Y001557NH02 . This is a "ANTHEM BCBS/BHN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2165404 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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