# PINE STATE TELEHEALTH THERAPY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1801631569
- **Authorized official:** MARY STANTON LCSW (OWNER)
- **Authorized official phone:** (207) 209-3123

## Contact information

- **Practice address:** 110 WILDERNESS LN, BOWDOINHAM, ME 04008-6059
- **Practice address phone:** (207) 209-3123
- **Mailing address:** PO BOX 231, RICHMOND, ME 04357-0231
- **Mailing address phone:** (207) 209-3123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 06/26/2024
- **Last updated:** 06/26/2024