Provider Demographics
NPI:1821463829
Name:WESTERN CONNECTICUT CENTER FOR NEUROFEEDBACK AND COUNSELING, LLC
Entity Type:Organization
Organization Name:WESTERN CONNECTICUT CENTER FOR NEUROFEEDBACK AND COUNSELING, LLC
Other - Org Name:FAMILY THERAPEUTIC COUNSELING MATTERS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, BCN, ORD
Authorized Official - Phone:203-482-5464
Mailing Address - Street 1:13 BERKSHIRE RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1361
Mailing Address - Country:US
Mailing Address - Phone:203-491-2577
Mailing Address - Fax:203-491-2579
Practice Address - Street 1:13 BERKSHIRE RD
Practice Address - Street 2:UNIT 1
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1361
Practice Address - Country:US
Practice Address - Phone:203-491-2577
Practice Address - Fax:203-491-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty