Provider Demographics
NPI:1023406592
Name:MYDISCOVER INC.
Entity type:Organization
Organization Name:MYDISCOVER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MLADC
Authorized Official - Phone:603-702-0117
Mailing Address - Street 1:50 SEAVEY ST
Mailing Address - Street 2:UNIT 2874
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-5355
Mailing Address - Country:US
Mailing Address - Phone:603-702-0117
Mailing Address - Fax:603-509-2405
Practice Address - Street 1:50 SEAVEY ST
Practice Address - Street 2:UNIT 2874
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5355
Practice Address - Country:US
Practice Address - Phone:603-702-0117
Practice Address - Fax:603-509-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0840251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health