Provider Demographics
NPI:1407291818
Name:COLLABORATIVE COUNSELING, LLC
Entity type:Organization
Organization Name:COLLABORATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-879-4424
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-0453
Mailing Address - Country:US
Mailing Address - Phone:203-879-4424
Mailing Address - Fax:203-879-4442
Practice Address - Street 1:1495 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-1321
Practice Address - Country:US
Practice Address - Phone:203-879-4424
Practice Address - Fax:203-879-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002310101YP2500X
CT0065621041C0700X
CT001113106H00000X
CT001496106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008040740Medicaid
CT008024276Medicaid