Provider Demographics
NPI:1912514605
Name:WELL BEYOND COUNSELING PLLC
Entity Type:Organization
Organization Name:WELL BEYOND COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL-SEAGRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-371-5668
Mailing Address - Street 1:2 TUNXIS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TARIFFVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06081-9687
Mailing Address - Country:US
Mailing Address - Phone:860-371-5668
Mailing Address - Fax:
Practice Address - Street 1:2 TUNXIS RD STE 201
Practice Address - Street 2:
Practice Address - City:TARIFFVILLE
Practice Address - State:CT
Practice Address - Zip Code:06081-9687
Practice Address - Country:US
Practice Address - Phone:860-371-5668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609218866OtherNPI