Provider Demographics
NPI:1750144481
Name:PRIDE AND VALOR THERAPY SERVICES LLC
Entity type:Organization
Organization Name:PRIDE AND VALOR THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER-KHODIK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-961-1354
Mailing Address - Street 1:62 NEWTON TER
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1919
Mailing Address - Country:US
Mailing Address - Phone:860-961-1354
Mailing Address - Fax:
Practice Address - Street 1:62 NEWTON TER
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1919
Practice Address - Country:US
Practice Address - Phone:860-961-1354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty