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General NPI Number Information
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NPI Number | 1164844320
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Entity Type | Organization
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Legal Business Name | KT COUNSELING ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 84 S MAIN ST BLDG C
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City | NEWTOWN
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State | CT
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Zip | 06470-2356
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Country | US
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Telephone | 203-270-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 84 S MAIN ST BLDG C
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City | NEWTOWN
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State | CT
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Zip | 06470-2356
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Country | US
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Telephone | 203-270-7070
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICAL DIRECTOR
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Name | DR. KIM M TASSINARI
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Credential | PH.D.
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Telephone | 203-270-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 001945
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License Number State | CT
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