Provider Demographics
NPI:1124410915
Name:ZEN MIND & BODY LLC
Entity Type:Organization
Organization Name:ZEN MIND & BODY LLC
Other - Org Name:COOPER COUNSELING & WELLNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-722-4405
Mailing Address - Street 1:85 OLD LONG RIDGE RD
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-1641
Mailing Address - Country:US
Mailing Address - Phone:203-722-4405
Mailing Address - Fax:
Practice Address - Street 1:85 OLD LONG RIDGE RD
Practice Address - Street 2:SUITE A-5
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-1641
Practice Address - Country:US
Practice Address - Phone:203-722-4405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty