Healthcare Provider Details

I. General information

NPI: 1689329641
Provider Name (Legal Business Name): LYS COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E CENTER ST
MANCHESTER CT
06040-5248
US

IV. Provider business mailing address

90 LUDLOW RD
MANCHESTER CT
06040-4543
US

V. Phone/Fax

Practice location:
  • Phone: 860-321-8572
  • Fax:
Mailing address:
  • Phone: 860-810-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEAN AMOS LYS
Title or Position: LICENSED THERAPIST
Credential: LMFT
Phone: 860-810-0166