Provider Demographics
NPI:1285404400
Name:WINDHAM WELLNESS
Entity type:Organization
Organization Name:WINDHAM WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST; CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCMHC, NCC, ACS
Authorized Official - Phone:802-266-4983
Mailing Address - Street 1:167 MAIN ST STE 207E
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3057
Mailing Address - Country:US
Mailing Address - Phone:802-266-4983
Mailing Address - Fax:
Practice Address - Street 1:167 MAIN ST STE 207E
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3057
Practice Address - Country:US
Practice Address - Phone:802-266-4983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty