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General NPI Number Information
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NPI Number | 1770207060
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Entity Type | Organization
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Legal Business Name | EBB & FLOW CREATIVE PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 147 COTTAGE ST APT A7
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City | NEW HAVEN
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State | CT
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Zip | 06511-2449
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Country | US
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Telephone | 203-479-0235
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Fax |
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Provider Business Mailing Address
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Address Line | 147 COTTAGE ST APT A7
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City | NEW HAVEN
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State | CT
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Zip | 06511-2449
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Country | US
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Telephone | 203-479-0235
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Fax |
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Authorized Official
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Title or Position | OWNER / LPC
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Name | MARY TESS HANNAFIN
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Credential | LPC
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Telephone | 203-479-0235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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