# EASTERN LIGHT PSYCHIATRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336915495
- **Authorized official:** MICHAEL SCOTT JR. APRN, PMHNP-BC (OWNER)
- **Authorized official phone:** (208) 313-9590

## Contact information

- **Practice address:** 333 BLAKES HILL RD, NORTHWOOD, NH 03261-3930
- **Practice address phone:** (208) 313-9590
- **Mailing address:** 333 BLAKES HILL RD, NORTHWOOD, NH 03261-3930
- **Mailing address phone:** (208) 313-9590

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/30/2023
- **Last updated:** 02/25/2024