Basic Information
Provider Information | |||||||||
NPI: | 1427323542 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ARTZ | ||||||||
FirstName: | AMANDA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS, LCMHC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MORRISETTE | ||||||||
OtherFirstName: | AMANDA | ||||||||
OtherMiddleName: | M | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | BA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 100 W PEARL ST | ||||||||
Address2: |   | ||||||||
City: | NASHUA | ||||||||
State: | NH | ||||||||
PostalCode: | 030603343 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6038896147 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 7 PROSPECT ST | ||||||||
Address2: |   | ||||||||
City: | NASHUA | ||||||||
State: | NH | ||||||||
PostalCode: | 030603990 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6038896147 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/22/2012 | ||||||||
LastUpdateDate: | 12/23/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/23/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X |   |   | N |   | Other Service Providers | Case Manager/Care Coordinator |   | 101YM0800X | 2287 | NH | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 2287 | 01 | NH | STATE OF NH | OTHER |