=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568843456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLE VALLEY BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2015
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 791 S MAIN ST
-----------------------------------------------------
City | PLANTSVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06479-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-631-5661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 791 S MAIN ST
-----------------------------------------------------
City | PLANTSVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06479-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-631-5661
-----------------------------------------------------
Fax | 860-378-8091
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOANNE ETTER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 203-631-5661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 002491
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------