Healthcare Provider Details

I. General information

NPI: 1275012148
Provider Name (Legal Business Name): GUILFORD HOLISTIC HEALTH PRACTITIONERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DURHAM RD STE B6
GUILFORD CT
06437
US

IV. Provider business mailing address

5 DURHAM RD STE B6
GUILFORD CT
06437-2076
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-1906
  • Fax: 203-453-2012
Mailing address:
  • Phone: 203-453-1906
  • Fax: 203-453-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number000058
License Number StateCT

VIII. Authorized Official

Name: DR. JEFFREY KLASS
Title or Position: PRESIDENT
Credential: ND
Phone: 203-453-1906