Provider Demographics
NPI:1851059224
Name:LIFT WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:LIFT WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-526-3215
Mailing Address - Street 1:8 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3511
Mailing Address - Country:US
Mailing Address - Phone:203-526-3215
Mailing Address - Fax:
Practice Address - Street 1:8 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3511
Practice Address - Country:US
Practice Address - Phone:203-526-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty