| Wanderlust Therapeutic Services, Pllc | |
|
400 Amherst St Ste 200 Nashua NH 03063-4223 | |
| (603) 889-3553 | |
| (603) 589-4981 |
| Full Name | Wanderlust Therapeutic Services, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 400 Amherst St Ste 200, Nashua, New Hampshire |
| Authorized Official Name and Position | Melbourne Richard Moran (PROPRIETOR) |
| Authorized Official Contact | 9784830182 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wanderlust Therapeutic Services, Pllc 400 Amherst St Ste 200 Nashua NH 03063-4223 Ph: (603) 889-3553 | Wanderlust Therapeutic Services, Pllc 400 Amherst St Ste 200 Nashua NH 03063-4223 Ph: (603) 889-3553 |
| NPI Number | 1225659600 |
|---|---|
| Provider Enumeration Date | 04/27/2020 |
| Last Update Date | 08/30/2024 |
| Certification Date | 08/30/2024 |
| Medicare PECOS PAC ID | 7012322753 |
|---|---|
| Medicare Enrollment ID | O20210210002846 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225659600 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Melbourne Richard Moran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871997379 PECOS PAC ID: 5698044618 Enrollment ID: I20190225002895 |
| Provider Name | Destiny Anne Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649620642 PECOS PAC ID: 6204283740 Enrollment ID: I20231106002536 |
| Provider Name | David Hutchings |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417445354 PECOS PAC ID: 0941651830 Enrollment ID: I20240104002376 |
| Provider Name | Clifford Bibeau |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508217340 PECOS PAC ID: 4082057138 Enrollment ID: I20240206003324 |
| Provider Name | Yvonne Hole |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750560603 PECOS PAC ID: 0446693386 Enrollment ID: I20240208000807 |
| Provider Name | Thomas P Lopez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396306171 PECOS PAC ID: 5496196636 Enrollment ID: I20240518000102 |
| Provider Name | Vanessa Wood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669986832 PECOS PAC ID: 0446792816 Enrollment ID: I20240613000837 |
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