Healthcare Provider Details

I. General information

NPI: 1578788766
Provider Name (Legal Business Name): BEHAVIORAL HEALTH CENTER FOR COUNSELING & LEARNING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 SOUTHFORD RD
MIDDLEBURY CT
06762-3234
US

IV. Provider business mailing address

984 SOUTHFORD RD
MIDDLEBURY CT
06762-3234
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-2400
  • Fax: 203-758-2415
Mailing address:
  • Phone: 203-758-2400
  • Fax: 203-758-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. NOEL FEDERLE
Title or Position: CO-OWNER
Credential: LPC
Phone: 203-758-2400