Provider Demographics
NPI:1659918126
Name:EXCEL YOURSELF NOW LLC
Entity Type:Organization
Organization Name:EXCEL YOURSELF NOW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-601-6499
Mailing Address - Street 1:297 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-1911
Mailing Address - Country:US
Mailing Address - Phone:203-601-6499
Mailing Address - Fax:
Practice Address - Street 1:297 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-1911
Practice Address - Country:US
Practice Address - Phone:203-601-6499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1568006526Medicaid