Provider Demographics
NPI:1629522446
Name:ISLES END COUNSELING, LLC
Entity Type:Organization
Organization Name:ISLES END COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-622-1980
Mailing Address - Street 1:3 FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-1162
Mailing Address - Country:US
Mailing Address - Phone:508-622-1980
Mailing Address - Fax:
Practice Address - Street 1:129 N MAIN ST # 305
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-3803
Practice Address - Country:US
Practice Address - Phone:508-864-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty