1043566334 NPI number — HOME BASE COLLABORATIVE FAMILY COUNSELING

Table of content: KYMBERLI SHERWOOD LMHC, ATR (NPI 1205270592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043566334 NPI number — HOME BASE COLLABORATIVE FAMILY COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME BASE COLLABORATIVE FAMILY COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1043566334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 ELM ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03104-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-998-5186
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 ELM ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03104-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-998-5186
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CALLAHAN
Authorized Official First Name:
KARIS
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
CO-DIRECTOR
Authorized Official Telephone Number:
603-998-5186

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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