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General NPI Number Information
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NPI Number | 1780920314
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Entity Type | Organization
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Legal Business Name | BETTER LIFE- MENTAL HEALTH LLC
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 15 RAINBOW RD
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City | BETHANY
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State | CT
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Zip | 06524-3145
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Country | US
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Telephone | 203-393-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 21 HAZEL TER SUITE B
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2209
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Country | US
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Telephone | 203-389-6000
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Fax | 203-389-6000
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Authorized Official
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Title or Position | OWNER
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Name | SHAUKAT A KHAN
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Credential | M.D.
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Telephone | 203-494-6206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 039209
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License Number State | CT
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