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General NPI Number Information
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NPI Number | 1932255726
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Entity Type | Individual
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Provider Name | JIM P MOUTINHO MS LPC LADC NCC
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 270 FARMINGTON AVE STE 328
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City | FARMINGTON
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State | CT
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Zip | 06032-1909
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Country | US
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Telephone | 866-887-6864
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Fax | 866-887-6864
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Provider Business Mailing Address
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Address Line | PO BOX 270642
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City | WEST HARTFORD
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State | CT
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Zip | 06127-0642
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Country | US
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Telephone | 866-887-6864
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Fax | 866-887-6864
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2231
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 797
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License Number State | CT
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