Provider Demographics
NPI:1497029961
Name:SYSTEMIC COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:SYSTEMIC COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:OPATRNY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-233-9179
Mailing Address - Street 1:357 WHITNEY AVE
Mailing Address - Street 2:C/O LOVINS GROUP
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2364
Mailing Address - Country:US
Mailing Address - Phone:203-233-9179
Mailing Address - Fax:203-624-7599
Practice Address - Street 1:357 WHITNEY AVE
Practice Address - Street 2:C/O LOVINS GROUP
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2364
Practice Address - Country:US
Practice Address - Phone:203-233-9179
Practice Address - Fax:203-624-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103TC0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001051OtherSTATE OF CT DEPT OF PUBLIC HEALTH LICENSE NUMBER - MFT