Provider Demographics
NPI:1669141297
Name:THE NEURO HEALTH CLINIC
Entity type:Organization
Organization Name:THE NEURO HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-208-6964
Mailing Address - Street 1:WEST ELM OFFICE COMMONS
Mailing Address - Street 2:1080 ELM ST SUITE 201
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067
Mailing Address - Country:US
Mailing Address - Phone:860-208-6964
Mailing Address - Fax:860-345-5928
Practice Address - Street 1:WEST ELM OFFICE COMMONS
Practice Address - Street 2:1080 ELM ST SUITE 201
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1847
Practice Address - Country:US
Practice Address - Phone:860-208-6964
Practice Address - Fax:860-345-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)