Provider Demographics
NPI:1184317075
Name:PORTLAND HUMANISTIC THERAPY LLC
Entity type:Organization
Organization Name:PORTLAND HUMANISTIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LCPC
Authorized Official - Prefix:
Authorized Official - First Name:PIER
Authorized Official - Middle Name:WOLF
Authorized Official - Last Name:FRANZEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:203-648-8715
Mailing Address - Street 1:602 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2324
Practice Address - Country:US
Practice Address - Phone:203-648-8715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty