Provider Demographics
NPI:1851718225
Name:COURAGE TO HEAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:COURAGE TO HEAL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHAYNA
Authorized Official - Middle Name:TERLENE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-518-1964
Mailing Address - Street 1:28 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1506
Mailing Address - Country:US
Mailing Address - Phone:860-518-1964
Mailing Address - Fax:888-685-3047
Practice Address - Street 1:28 GRAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1506
Practice Address - Country:US
Practice Address - Phone:860-518-1964
Practice Address - Fax:888-685-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008041510Medicaid