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General NPI Number Information
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NPI Number | 1538673421
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Entity Type | Organization
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Legal Business Name | MOMENTUM COUNSELING & WELLNESS
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 62 LASALLE RD STE 216
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2306
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Country | US
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Telephone | 860-206-4505
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Fax | 860-206-4707
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Provider Business Mailing Address
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Address Line | 62 LASALLE RD STE 216
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2306
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Country | US
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Telephone | 860-206-4505
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Fax | 860-206-4707
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/ OWNER
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Name | DR. MEAGAN LEDUC-MEYER
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Credential | PSYD
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Telephone | 860-206-4505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 003207
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License Number State | CT
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