Provider Demographics
NPI:1598242992
Name:MGR WELLNESS COUNSELING LLC
Entity Type:Organization
Organization Name:MGR WELLNESS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASTRIANNO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-488-8146
Mailing Address - Street 1:94 WOOD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:CT
Mailing Address - Zip Code:06751-1705
Mailing Address - Country:US
Mailing Address - Phone:203-510-7054
Mailing Address - Fax:
Practice Address - Street 1:14 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787
Practice Address - Country:US
Practice Address - Phone:203-510-7054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)