Provider Demographics
NPI:1881904837
Name:HUNTINGTON COUNSELING CENTER
Entity type:Organization
Organization Name:HUNTINGTON COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-929-1234
Mailing Address - Street 1:8 HUNTINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5212
Mailing Address - Country:US
Mailing Address - Phone:203-929-1234
Mailing Address - Fax:
Practice Address - Street 1:330 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3861
Practice Address - Country:US
Practice Address - Phone:203-929-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty