Provider Demographics
NPI:1932661709
Name:PROVIDENT PROPERTIES LLC
Entity Type:Organization
Organization Name:PROVIDENT PROPERTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-215-2829
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-0623
Mailing Address - Country:US
Mailing Address - Phone:860-215-2829
Mailing Address - Fax:
Practice Address - Street 1:283 ROUTE 169
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-0628
Practice Address - Country:US
Practice Address - Phone:860-215-2829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164870200OtherINDIVIDUAL NPI