Provider Demographics
NPI:1588228233
Name:BEYOND WELLNESS LLC
Entity Type:Organization
Organization Name:BEYOND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-626-1839
Mailing Address - Street 1:357 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4912
Mailing Address - Country:US
Mailing Address - Phone:203-984-2264
Mailing Address - Fax:
Practice Address - Street 1:67 S COLONY ROAD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4150
Practice Address - Country:US
Practice Address - Phone:203-626-1839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1538634316Medicaid