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General NPI Number Information
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NPI Number | 1972788271
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Entity Type | Organization
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Legal Business Name | WRH MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 141 N MAIN ST
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City | BRANFORD
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State | CT
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Zip | 06405-3018
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Country | US
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Telephone | 203-315-8012
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Fax | 203-315-8013
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Provider Business Mailing Address
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Address Line | 141 N MAIN ST
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City | BRANFORD
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State | CT
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Zip | 06405-3018
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Country | US
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Telephone | 203-315-8012
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Fax | 203-315-8013
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM RAYMOND HENDRIXSON
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Credential | APRN
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Telephone | 203-315-8012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 001669
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 001669
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License Number State | CT
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