Organization
OLDE PORT COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW FOWLER LMFT (MEMBER)
(603) 531-8811
Entity
Organization
Contact information
Practice address
406 THE HL, PORTSMOUTH, NH 03801-3736
(978) 432-9560
Mailing address
406 THE HL, PORTSMOUTH, NH 03801-3736
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3078870
—
NH
Enumeration date
05/01/2019
Last updated
06/14/2023
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