Healthcare Provider Details

I. General information

NPI: 1992232656
Provider Name (Legal Business Name): TOUCHING YOUNG HEARTS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 E MAIN ST
CLINTON CT
06413-2294
US

IV. Provider business mailing address

252 E MAIN ST
CLINTON CT
06413-2294
US

V. Phone/Fax

Practice location:
  • Phone: 203-493-1558
  • Fax:
Mailing address:
  • Phone: 203-493-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002962
License Number StateCT

VIII. Authorized Official

Name: MS. CLAIRLYN ELIZABETH DAVIS
Title or Position: MEMBER
Credential: LPC
Phone: 203-493-1558