Healthcare Provider Details

I. General information

NPI: 1407538143
Provider Name (Legal Business Name): EVER CHANGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 WILKENDA AVE
WATERBURY CT
06708-3656
US

IV. Provider business mailing address

290 WILKENDA AVE
WATERBURY CT
06708-3656
US

V. Phone/Fax

Practice location:
  • Phone: 203-910-9638
  • Fax:
Mailing address:
  • Phone: 203-910-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELENA CELA
Title or Position: OWNER/MEMBER
Credential: PSY.D., LPC, NCC
Phone: 203-910-9638