Provider Demographics
NPI:1821746876
Name:WESTERN CONNECTICUT COUNSELING LLC
Entity Type:Organization
Organization Name:WESTERN CONNECTICUT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:203-673-1099
Mailing Address - Street 1:28 CHURCH RD APT A1
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3890
Mailing Address - Country:US
Mailing Address - Phone:203-673-1099
Mailing Address - Fax:
Practice Address - Street 1:33 BULLET HILL RD STE 216
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4699
Practice Address - Country:US
Practice Address - Phone:203-673-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health