Provider Demographics
NPI:1770207060
Name:EBB & FLOW CREATIVE PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:EBB & FLOW CREATIVE PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LPC
Authorized Official - Prefix:
Authorized Official - First Name:MARY TESS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNAFIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-479-0235
Mailing Address - Street 1:147 COTTAGE ST APT A7
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2449
Mailing Address - Country:US
Mailing Address - Phone:203-479-0235
Mailing Address - Fax:
Practice Address - Street 1:147 COTTAGE ST APT A7
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2449
Practice Address - Country:US
Practice Address - Phone:203-479-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty