Provider Demographics
NPI:1932255726
Name:MOUTINHO, JIM P (MS LPC LADC NCC)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:P
Last Name:MOUTINHO
Suffix:
Gender:M
Credentials:MS LPC LADC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 270642
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06127-0642
Mailing Address - Country:US
Mailing Address - Phone:866-887-6864
Mailing Address - Fax:866-887-6864
Practice Address - Street 1:270 FARMINGTON AVE STE 328
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1909
Practice Address - Country:US
Practice Address - Phone:866-887-6864
Practice Address - Fax:866-887-6864
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2231101YP2500X
CT797101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional