Healthcare Provider Details

I. General information

NPI: 1215156583
Provider Name (Legal Business Name): CHRISTINE KAY SEYMOUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 N STONE ST
WEST SUFFIELD CT
06093-3214
US

IV. Provider business mailing address

559 N STONE ST
WEST SUFFIELD CT
06093-3214
US

V. Phone/Fax

Practice location:
  • Phone: 860-254-5055
  • Fax: 860-254-5055
Mailing address:
  • Phone: 860-254-5055
  • Fax: 860-254-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0011211
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: