Provider Demographics
NPI:1538673421
Name:MOMENTUM COUNSELING & WELLNESS
Entity Type:Organization
Organization Name:MOMENTUM COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDUC-MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-206-4505
Mailing Address - Street 1:62 LASALLE RD STE 216
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2306
Mailing Address - Country:US
Mailing Address - Phone:860-206-4505
Mailing Address - Fax:860-206-4707
Practice Address - Street 1:62 LASALLE RD STE 216
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2306
Practice Address - Country:US
Practice Address - Phone:860-206-4505
Practice Address - Fax:860-206-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003207103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty