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General NPI Number Information
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NPI Number | 1821420977
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Entity Type | Organization
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Legal Business Name | JUST BREATHE CONNECTICUT LLC
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 420 SOMERS RD
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City | ELLINGTON
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State | CT
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Zip | 06029-2629
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Country | US
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Telephone | 860-255-4475
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Fax |
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Provider Business Mailing Address
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Address Line | 420 SOMERS RD
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City | ELLINGTON
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State | CT
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Zip | 06029-2629
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Country | US
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Telephone | 860-255-4475
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KERRY LYNN TUTTLE
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Credential |
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Telephone | 860-255-4475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002689
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 005794
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License Number State | CT
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