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General NPI Number Information
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NPI Number | 1396289344
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Entity Type | Organization
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Legal Business Name | ATLAS OUTLOOK
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Dates
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Enumeration Date | 12/10/2016
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Last Update Date | 12/10/2016
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Provider Practice Location Address
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Address Line | 1429 PARK ST RESET FIRST FLOOR
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City | HARTFORD
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State | CT
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Zip | 06106-2236
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Country | US
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Telephone | 860-685-1254
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Fax |
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Provider Business Mailing Address
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Address Line | 1429 PARK ST RESET FIRST FLOOR
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City | HARTFORD
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State | CT
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Zip | 06106-2236
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Country | US
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Telephone | 860-685-1254
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | TAMI MENDEZ
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Credential |
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Telephone | 860-685-1254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001390
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002560
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License Number State | CT
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