Basic Information
| Provider Information | |||||||||
| NPI: | 1861815094 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENDURANCE BEHAVIORAL HEALTH PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 867 LAFAYETTE RD | ||||||||
| Address2: | P.O. BOX 2899 | ||||||||
| City: | SEABROOK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038744217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039184222 | ||||||||
| FaxNumber: | 6037601949 | ||||||||
| Practice Location | |||||||||
| Address1: | 823 LAFAYETTE RD | ||||||||
| Address2: | |||||||||
| City: | SEABROOK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038744215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037601942 | ||||||||
| FaxNumber: | 6037601949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2014 | ||||||||
| LastUpdateDate: | 11/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS/MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6039184222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 314057 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 103TC2200X | 1292 | NH | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.