Provider Demographics
NPI:1336526193
Name:KEEP AN OPEN MIND, LLC
Entity Type:Organization
Organization Name:KEEP AN OPEN MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-886-0015
Mailing Address - Street 1:12 CASS STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORWICH
Mailing Address - State:DC
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-886-0015
Mailing Address - Fax:860-886-0015
Practice Address - Street 1:12 CASS STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:NORWICH
Practice Address - State:DC
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-886-0015
Practice Address - Fax:860-886-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty