Provider Demographics
NPI:1104374735
Name:PASSAGES BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:PASSAGES BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:603-577-0665
Mailing Address - Street 1:3 PINE STREET EXT
Mailing Address - Street 2:UNIT B
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3275
Mailing Address - Country:US
Mailing Address - Phone:603-577-0665
Mailing Address - Fax:
Practice Address - Street 1:3 PINE STREET EXT
Practice Address - Street 2:UNIT B
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3275
Practice Address - Country:US
Practice Address - Phone:603-577-0665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE7969Medicare PIN