Provider Demographics
NPI:1902991599
Name:BASTILLE, ANN (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BASTILLE
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BARRETTS HILL RD
Mailing Address - Street 2:UNIT R
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3524
Mailing Address - Country:US
Mailing Address - Phone:603-889-3443
Mailing Address - Fax:603-594-8741
Practice Address - Street 1:132 BARRETTS HILL RD
Practice Address - Street 2:UNIT R
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-3524
Practice Address - Country:US
Practice Address - Phone:603-889-3443
Practice Address - Fax:603-594-8741
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH42101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health