1306224720 NPI number — HAEDEN PEASLEE LMHC #11069

Table of content: HAEDEN PEASLEE LMHC #11069 (NPI 1306224720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306224720 NPI number — HAEDEN PEASLEE LMHC #11069

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEASLEE
Provider First Name:
HAEDEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC #11069
Provider Gender Code:
M

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:
1306224720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 42
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BILLERICA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01862-0042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-294-9674
Provider Business Mailing Address Fax Number:
857-362-1603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01851-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-294-9674
Provider Business Practice Location Address Fax Number:
857-362-1603
Provider Enumeration Date:
05/18/2015

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11069 . This is a "LMHC BOARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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