Healthcare Provider Details

I. General information

NPI: 1053224345
Provider Name (Legal Business Name): STACEY JILL FLOWERS LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MAIN ST STE 3
WINSTED CT
06098-1577
US

IV. Provider business mailing address

7 TOWER DR
SIMSBURY CT
06070-1236
US

V. Phone/Fax

Practice location:
  • Phone: 860-815-8157
  • Fax:
Mailing address:
  • Phone: 860-878-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10170
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: