Healthcare Provider Details

I. General information

NPI: 1639940398
Provider Name (Legal Business Name): BEYOND HEALING COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/12/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 SOUTH RD STE 128
ENFIELD CT
06082-4414
US

IV. Provider business mailing address

621 MATIANUCK AVE
WINDSOR CT
06095-3540
US

V. Phone/Fax

Practice location:
  • Phone: 860-881-5075
  • Fax:
Mailing address:
  • Phone: 860-881-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELICA RODRIGUEZ
Title or Position: OWNER/ AUTHORIZED OFFICIAL
Credential: LPC
Phone: 860-881-5075