Healthcare Provider Details

I. General information

NPI: 1972788271
Provider Name (Legal Business Name): WRH MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N MAIN ST
BRANFORD CT
06405-3018
US

IV. Provider business mailing address

141 N MAIN ST
BRANFORD CT
06405-3018
US

V. Phone/Fax

Practice location:
  • Phone: 203-315-8012
  • Fax: 203-315-8013
Mailing address:
  • Phone: 203-315-8012
  • Fax: 203-315-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number001669
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number001669
License Number StateCT

VIII. Authorized Official

Name: MR. WILLIAM RAYMOND HENDRIXSON
Title or Position: OWNER
Credential: APRN
Phone: 203-315-8012