Provider Demographics
NPI:1578788766
Name:BEHAVIORAL HEALTH CENTER FOR COUNSELING & LEARNING, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH CENTER FOR COUNSELING & LEARNING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDERLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-758-2400
Mailing Address - Street 1:984 SOUTHFORD RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-3234
Mailing Address - Country:US
Mailing Address - Phone:203-758-2400
Mailing Address - Fax:203-758-2415
Practice Address - Street 1:984 SOUTHFORD RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-3234
Practice Address - Country:US
Practice Address - Phone:203-758-2400
Practice Address - Fax:203-758-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP2500X, 106H00000X, 2084P0800X
364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty