Healthcare Provider Details

I. General information

NPI: 1043684145
Provider Name (Legal Business Name): CATALYST COUNSELING OF CONNECTICUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 COVEY RD 2AF
BURLINGTON CT
06013-1720
US

IV. Provider business mailing address

9 COVEY RD 2AF
BURLINGTON CT
06013-1720
US

V. Phone/Fax

Practice location:
  • Phone: 860-550-1490
  • Fax:
Mailing address:
  • Phone: 860-550-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001166
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2901
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2901
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number001166
License Number StateCT

VIII. Authorized Official

Name: KELLY TAYLOR
Title or Position: THERAPIST
Credential: LADC
Phone: 860-550-1490