Provider Demographics
NPI:1700550803
Name:ELEPHANT ON THE COUCH
Entity Type:Organization
Organization Name:ELEPHANT ON THE COUCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANNI
Authorized Official - Middle Name:KORYN
Authorized Official - Last Name:COGDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-650-8679
Mailing Address - Street 1:1345 BARNUM AVENUE
Mailing Address - Street 2:PMB 260
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614
Mailing Address - Country:US
Mailing Address - Phone:203-650-8679
Mailing Address - Fax:
Practice Address - Street 1:1345 BARNUM AVENUE
Practice Address - Street 2:PMB 260
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614
Practice Address - Country:US
Practice Address - Phone:203-650-8679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health